Provider Demographics
NPI:1174012355
Name:NIELSON, ALEX L (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:L
Last Name:NIELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E 33RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-2776
Mailing Address - Country:US
Mailing Address - Phone:360-514-7560
Mailing Address - Fax:
Practice Address - Street 1:KIRKPATRICK FAMILY CARE
Practice Address - Street 2:1706 WASHINGTON WAY
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2495
Practice Address - Country:US
Practice Address - Phone:360-423-0390
Practice Address - Fax:360-577-3865
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61130110207Q00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program