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General NPI Number Information
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NPI Number | 1427540327
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Entity Type | Individual
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Provider Name | NATHANIEL THOMAS NIELSEN DO
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Gender | Male
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 2609 GLENN HENDREN DR
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City | LIBERTY
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State | MO
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Zip | 64068-3313
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Country | US
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Telephone | 816-781-7730
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Fax |
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Provider Business Mailing Address
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Address Line | 2609 GLENN HENDREN DR
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City | LIBERTY
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State | MO
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Zip | 64068-3313
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Country | US
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Telephone | 816-781-7730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 29186
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 66368
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2023031789
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License Number State | MO
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