Provider Demographics
NPI:1538133897
Name:NIELSEN, LANI D (CNM)
Entity Type:Individual
Prefix:
First Name:LANI
Middle Name:D
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 STONECROP CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-3506
Mailing Address - Country:US
Mailing Address - Phone:970-204-1345
Mailing Address - Fax:
Practice Address - Street 1:1006 STONECROP CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-3506
Practice Address - Country:US
Practice Address - Phone:970-204-1345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO57293367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2136538Medicaid
CO2136538Medicaid
COC800056Medicare PIN