Provider Demographics
NPI:1295604205
Name:NIESEN, MIKAELA (RN)
Entity type:Individual
Prefix:
First Name:MIKAELA
Middle Name:
Last Name:NIESEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4765 S GARLAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1047
Mailing Address - Country:US
Mailing Address - Phone:619-895-7707
Mailing Address - Fax:
Practice Address - Street 1:4765 S GARLAND ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-1047
Practice Address - Country:US
Practice Address - Phone:619-895-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1671072163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse