Healthcare Provider Details

I. General information

NPI: 1174521082
Provider Name (Legal Business Name): WILLIAM M NIELSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7370 TURFWAY RD STE 302
FLORENCE KY
41042
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-371-4020
  • Fax: 859-746-7464
Mailing address:
  • Phone: 859-212-0175
  • Fax: 859-441-3698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00165
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: