Provider Demographics
NPI:1437678844
Name:NEILSEN, AKIRA THOMAS
Entity Type:Individual
Prefix:
First Name:AKIRA
Middle Name:THOMAS
Last Name:NEILSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 SW RIVER DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-8054
Mailing Address - Country:US
Mailing Address - Phone:971-239-8080
Mailing Address - Fax:
Practice Address - Street 1:1930 SW RIVER DRIVE
Practice Address - Street 2:UNIT 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201
Practice Address - Country:US
Practice Address - Phone:971-239-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program