Provider Demographics
NPI:1497006654
Name:NILSON, STEVEN A (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:A
Last Name:NILSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-5427
Mailing Address - Country:US
Mailing Address - Phone:608-362-1234
Mailing Address - Fax:608-362-2744
Practice Address - Street 1:1006 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-5427
Practice Address - Country:US
Practice Address - Phone:608-362-1234
Practice Address - Fax:608-362-2744
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33065700Medicaid
WI33065700Medicaid