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NPI Code Detail

MEDICARE: THERESA F NIELSEN FNP

MEDICARE: THERESA F NIELSEN FNP
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
1363LF0000XFamily Nurse PractitionerAP128179TX
2363LF0000XFamily Nurse Practitioner6696CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851462717
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA F NIELSEN FNP
Provider Business Mailing Address
First Line : 2960 TONGASS AVE
Second Line :
City : KETCHIKAN
State : AK
Zip : 99901-5742
Country : US
Telephone Number : 907-228-4900
Fax Number : 800-852-3264
Provider Business Practice Location Address
First Line : 2960 TONGASS AVE
Second Line :
City : KETCHIKAN
State : AK
Zip : 99901-5742
Country : US
Telephone Number : 907-228-4900
Fax Number : 800-852-3264
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2006
Last Update Date : 09/06/2016

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