Provider Demographics
NPI:1053946459
Name:NIEVES, JEAN PIERE RIVERA (PA)
Entity type:Individual
Prefix:
First Name:JEAN PIERE
Middle Name:RIVERA
Last Name:NIEVES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:JEAN PIERE
Other - Middle Name:
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2904 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7053
Mailing Address - Country:US
Mailing Address - Phone:253-286-4142
Mailing Address - Fax:
Practice Address - Street 1:10004 204TH AVE E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-6539
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-05
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61031699363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical