Provider Demographics
NPI:1568630887
Name:NIELSEN, ALICIA KONNEKER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:KONNEKER
Last Name:NIELSEN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7940 WILLIAMS POND LN
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8766
Mailing Address - Country:US
Mailing Address - Phone:704-752-7779
Mailing Address - Fax:704-752-7775
Practice Address - Street 1:7940 WILLIAMS POND LN
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8766
Practice Address - Country:US
Practice Address - Phone:704-752-7779
Practice Address - Fax:704-752-7775
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2010-05-10
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Provider Licenses
StateLicense IDTaxonomies
NC0010-01222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant