Provider Demographics
NPI:1457170326
Name:PUE, NICHOLAS WILLIAM
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:PUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 DOE CRST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-1483
Mailing Address - Country:US
Mailing Address - Phone:210-240-4568
Mailing Address - Fax:210-443-0308
Practice Address - Street 1:1734 DOE CRST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78248-1483
Practice Address - Country:US
Practice Address - Phone:210-240-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX829965171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator