Provider Demographics
NPI:1497851026
Name:NIELSEN, LAURA W (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:W
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 W DODGE RD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3451
Mailing Address - Country:US
Mailing Address - Phone:402-955-6877
Mailing Address - Fax:402-955-6880
Practice Address - Street 1:110 N 175TH ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-3582
Practice Address - Country:US
Practice Address - Phone:402-955-5437
Practice Address - Fax:402-955-7310
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18328208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47068937201Medicaid
NE31401OtherBCBS
IA96451OtherBCBS
NE719OtherMIDLANDS CHOICE
IA986901Medicaid