| Doctor Name: | NANCI ROTH NILLES |
| NPI Number: | 1285629493 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | 20041814A |
| Business Practice Address: | 2134 Mary Sherman Dr Sullivan, IN - 478827625 |
| Business Phone Number: | 8122686376 |
| Business Fax Number: | 8122686377 |
| Mailing Address: | 2134 Mary Sherman Dr, SULLIVAN |
| State: | IN |
| Postal Code: | 478827625 |
| Phone Number: | 8122686376 |
| Fax Number: | 8122686377 |
| NPI Enumeration Date: | 09/14/2005 |
| NPI Last Update Date: | 05/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 20041814A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |