Guinevere M Nilles, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10001910A Issued in IN

Practice address

7910 W Jefferson Blvd Ste 108
Fort Wayne, IN 46804-4159

Phone

(260) 484-8830

Fax

(260) 483-1911

NPI assigned

Apr 30, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neossia Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fort Wayne, IN
  • NPI 1295396810
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1430352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595462400000",
    "number": "1265819064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6610 MUTUAL DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468254236",
            "telephone_number": "260-484-8830",
            "fax_number": "260-483-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD STE 108",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-484-8830",
            "fax_number": "260-483-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NILLES",
        "first_name": "GUINEVERE",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-30",
        "last_updated": "2020-07-23",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IN",
            "license": "10001910A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nightingale Hospice Care of Northern Indiana, Inc.
• Nihcs
• Nill Family Chiropractic & Wellness Center, LLC
• James Patrick Nill, DC
• Thomas G Nill, MD
• David Keith Niner, SLP
• Holly Niner
• Kaitlin Marie Nini, MSSA, LCSW
• Ana L Nino, RBT
• Raven Nino

• Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.