MEDICARE: DR. NIELS C S NIELSEN MD

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
1	2084P0800X	Psychiatry Physician	MD60133289	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497969893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIELS C S NIELSEN MD

Provider Business Mailing Address
First Line	:	4020 E MADISON ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3150
Country	:	US
Telephone Number	:	206-456-2559
Fax Number	:	888-419-3592

Provider Business Practice Location Address
First Line	:	4020 E MADISON ST STE 240
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-3150
Country	:	US
Telephone Number	:	206-456-2559
Fax Number	:	888-419-3592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	05/25/2022

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