Provider Demographics
NPI:1053761676
Name:VADIEI, NINA
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:
Last Name:VADIEI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 HARMON AVE APT 469
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2375
Mailing Address - Country:US
Mailing Address - Phone:512-716-9055
Mailing Address - Fax:
Practice Address - Street 1:3400 HARMON AVE APT 469
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2375
Practice Address - Country:US
Practice Address - Phone:512-716-9055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX566121835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric