Provider Demographics
NPI:1598588170
Name:NIVER, VIRGINIA LELLE (PA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LELLE
Last Name:NIVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0640
Mailing Address - Country:US
Mailing Address - Phone:252-536-5844
Mailing Address - Fax:252-519-0154
Practice Address - Street 1:270 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-537-0134
Practice Address - Fax:252-537-6515
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant