Provider Demographics
NPI:1497969893
Name:NIELSEN, NIELS C S (MD)
Entity Type:Individual
Prefix:DR
First Name:NIELS
Middle Name:C S
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 E MADISON ST STE 240
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3150
Mailing Address - Country:US
Mailing Address - Phone:206-456-2559
Mailing Address - Fax:888-419-3592
Practice Address - Street 1:4020 E MADISON ST STE 240
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-3150
Practice Address - Country:US
Practice Address - Phone:206-456-2559
Practice Address - Fax:888-419-3592
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD601332892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA20089895Medicaid
WA20089895Medicaid