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General NPI Number Information
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NPI Number | 1972589398
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Entity Type | Individual
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Provider Name | STEPHEN M NILSEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2005
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 8100 SANDPIPER CIR STE 210
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City | NOTTINGHAM
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State | MD
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Zip | 21236-4992
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Country | US
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Telephone | 855-527-7246
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Fax | 866-229-5063
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Provider Business Mailing Address
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Address Line | 28665 EARTHLITE RD
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City | WYE MILLS
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State | MD
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Zip | 21679-2024
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Country | US
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Telephone | 410-827-7188
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Fax | 410-827-7076
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | DO33153
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | H0058012
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License Number State | MD
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