Healthcare Provider Details

I. General information

NPI: 1457313025
Provider Name (Legal Business Name): PAUL W. NIELSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL PLZ
GRAFTON WV
26354-1283
US

IV. Provider business mailing address

1 HOSPITAL PLZ
GRAFTON WV
26354-1283
US

V. Phone/Fax

Practice location:
  • Phone: 304-265-0400
  • Fax: 304-265-6443
Mailing address:
  • Phone: 304-265-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1539
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: