Healthcare Provider Details

I. General information

NPI: 1215919311
Provider Name (Legal Business Name): BRETT R. NIELSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 EAST NORTH AVENUE
PITTSBURGH PA
15212
US

IV. Provider business mailing address

3060 WHITE PINE DRIVE
GIBSONIA PA
15044
US

V. Phone/Fax

Practice location:
  • Phone: 254-383-7282
  • Fax:
Mailing address:
  • Phone: 254-383-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01058345A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: