Provider Demographics
NPI:1497030548
Name:NIELSEN, PAIGE MAURAN (OD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MAURAN
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:MAURAN
Other - Last Name:BOSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1508
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1508
Mailing Address - Country:US
Mailing Address - Phone:307-331-8440
Mailing Address - Fax:
Practice Address - Street 1:212 W 9TH ST
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001
Practice Address - Country:US
Practice Address - Phone:308-345-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY401T152W00000X
SD740152W00000X
NE1413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist