Provider Demographics
NPI:1558960963
Name:NYLEN, STEVEN JAMES JR
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:NYLEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MALIBU DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451-1211
Mailing Address - Country:US
Mailing Address - Phone:815-274-2110
Mailing Address - Fax:
Practice Address - Street 1:1010 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1278
Practice Address - Country:US
Practice Address - Phone:715-748-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18642-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist