Healthcare Provider Details

I. General information

NPI: 1447787890
Provider Name (Legal Business Name): KAYLA JANE NIELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 W MAIN ST
ELMA WA
98541-9394
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-861-8710
  • Fax: 360-861-8717
Mailing address:
  • Phone: 206-764-0502
  • Fax: 206-764-0516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60485304
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: