Provider Demographics
NPI:1588641203
Name:NIELSEN, ERIC LELAND (RN)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:LELAND
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-1058
Mailing Address - Country:US
Mailing Address - Phone:414-628-4114
Mailing Address - Fax:
Practice Address - Street 1:500 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-1058
Practice Address - Country:US
Practice Address - Phone:414-628-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119245-030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health