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NPI Code Detail

MEDICARE: MS. PATRICIA DEYOUNG NIELSEN NP

MEDICARE: MS. PATRICIA DEYOUNG NIELSEN NP
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
1363L00000XNurse Practitioner201245NC

General Provider Information

NPI Number : 1588692255
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA DEYOUNG NIELSEN NP
Provider Business Mailing Address
First Line : PO BOX 936857
Second Line :
City : ATLANTA
State : GA
Zip : 31193-6857
Country : US
Telephone Number : 910-662-9300
Fax Number : 910-662-2401
Provider Business Practice Location Address
First Line : 2150 SHIPYARD BLVD
Second Line :
City : WILMINGTON
State : NC
Zip : 28403-8052
Country : US
Telephone Number : 910-667-9402
Fax Number : 877-665-4450
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 12/12/2022

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