Provider Demographics
NPI:1083231609
Name:NIELSEN, JOHN VENDELBOE (RD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:VENDELBOE
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 NW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4203
Mailing Address - Country:US
Mailing Address - Phone:515-822-2639
Mailing Address - Fax:
Practice Address - Street 1:507 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4203
Practice Address - Country:US
Practice Address - Phone:515-822-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered