MEDICARE: MARK ANDREW NIELSEN M.D.

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	207R00000X	Internal Medicine Physician	17897	NE

General Provider Information

NPI Number	:	1730152984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW NIELSEN M.D.

Provider Business Mailing Address
First Line	:	611 W FRANCIS ST
Second Line	:	SUITE 110
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-0620
Country	:	US
Telephone Number	:	308-534-2532
Fax Number	:	308-534-6615

Provider Business Practice Location Address
First Line	:	611 W FRANCIS ST
Second Line	:	SUITE 110
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-0620
Country	:	US
Telephone Number	:	308-534-2532
Fax Number	:	308-534-6615

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	08/29/2012

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