Provider Demographics
NPI:1093177735
Name:NIELSEN, JOHN (LPN)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7237
Mailing Address - Country:US
Mailing Address - Phone:585-281-0374
Mailing Address - Fax:
Practice Address - Street 1:276 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7237
Practice Address - Country:US
Practice Address - Phone:585-281-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229264164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse