Healthcare Provider Details

I. General information

NPI: 1386518215
Provider Name (Legal Business Name): ANGIE NIELSEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 DOCTORS PARK DR STE C
COLUMBUS IN
47203-2376
US

IV. Provider business mailing address

1950 DOCTORS PARK DR STE C
COLUMBUS IN
47203-2376
US

V. Phone/Fax

Practice location:
  • Phone: 812-343-9002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA NIELSEN
Title or Position: OWNER
Credential:
Phone: 812-343-9002