Healthcare Provider Details

I. General information

NPI: 1104264696
Provider Name (Legal Business Name): LEIF ERIK NIELSEN CABI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 03/28/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 PYRAMID WAY STE B
SPARKS NV
89431-1865
US

IV. Provider business mailing address

1566 WILDRYE DR
RENO NV
89509-6904
US

V. Phone/Fax

Practice location:
  • Phone: 775-657-8309
  • Fax:
Mailing address:
  • Phone: 775-400-7697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCABIT042513
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: