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General NPI Number Information
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NPI Number | 1467352195
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Entity Type | Individual
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Provider Name | MARY KRISTIN NIELSEN RN
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Gender | Female
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Dates
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Enumeration Date | 11/06/2026
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Last Update Date | 11/06/2026
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Provider Practice Location Address
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Address Line | 640 S WOODRUFF AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83401-5299
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Country | US
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Telephone | 208-522-2922
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Fax | 801-584-1223
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Provider Business Mailing Address
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Address Line | 7233 W 33RD S
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City | IDAHO FALLS
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State | ID
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Zip | 83402-5968
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Country | US
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Telephone | 208-522-2922
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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 | 163WP2201X
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Taxonomy Name | Ambulatory Care Registered Nurse
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License Number | N41464
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License Number State | ID
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