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NPI Code Detail

MEDICARE: AVERY ROSS NIELSEN

MEDICARE:   AVERY ROSS 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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1821682501
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVERY ROSS NIELSEN
Provider Business Mailing Address
First Line : 2106 HERITAGE OAKS CT
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-5300
Country : US
Telephone Number : 904-327-3469
Fax Number :
Provider Business Practice Location Address
First Line : 2106 HERITAGE OAKS CT
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-5300
Country : US
Telephone Number : 904-327-3469
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2021
Last Update Date : 02/23/2021

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Directions to “ AVERY ROSS NIELSEN ” Practice Location

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