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NPI Code Detail

MEDICARE: CHARLES LEVI NIELSEN DO

MEDICARE: CHARLES LEVI NIELSEN DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine PhysicianDR.0066360CO

General Provider Information

NPI Number : 1497247837
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LEVI NIELSEN DO
Provider Business Mailing Address
First Line : 2695 ROCKY MOUNTAIN AVE STE 150
Second Line :
City : LOVELAND
State : CO
Zip : 80538-9071
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 320 E FONTANERO ST STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80907-7535
Country : US
Telephone Number : 719-365-7420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2018
Last Update Date : 09/13/2021

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Directions to “ CHARLES LEVI NIELSEN DO” Practice Location

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