MEDICARE: ALYSSA NIELSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	119479	MN

General Provider Information

NPI Number	:	1568757128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA NIELSEN

Provider Business Mailing Address
First Line	:	7000 YORK AVE S
Second Line	:	T-2313
City	:	EDINA
State	:	MN
Zip	:	55435-4213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 YORK AVE S
Second Line	:	T-2313
City	:	EDINA
State	:	MN
Zip	:	55435-4213
Country	:	US
Telephone Number	:	952-925-4250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2011
Last Update Date	:	06/12/2011

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Directions to “ ALYSSA NIELSEN ” Practice Location

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