Individual
ISRAEL NIETO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4900 BROADWAY, GARY, IN 46408-4605
(219) 237-5170
(219) 321-1931
Mailing address
PO BOX 746721, ATLANTA, GA 30374-6721
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007936A
IN
Other
Enumeration date
05/02/2018
Last updated
09/09/2024
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