Healthcare Provider Details

I. General information

NPI: 1821308008
Provider Name (Legal Business Name): KIRSTEN NIELSEN N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 12/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 ELMWOOD AVE # 332
BURLINGTON VT
05401-4366
US

IV. Provider business mailing address

PO BOX 332
BURLINGTON VT
05402-0332
US

V. Phone/Fax

Practice location:
  • Phone: 802-735-5989
  • Fax:
Mailing address:
  • Phone: 802-735-5989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0093557
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: