Healthcare Provider Details

I. General information

NPI: 1891825311
Provider Name (Legal Business Name): CINDY ELAINE NIELSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 305TH ST
TAMA IA
52339-9634
US

IV. Provider business mailing address

305 N CHURCH ST
TOLEDO IA
52342-1505
US

V. Phone/Fax

Practice location:
  • Phone: 641-484-4094
  • Fax:
Mailing address:
  • Phone: 641-484-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA76883
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01964
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: