Provider Demographics
NPI:1821308008
Name:NIELSEN, KIRSTEN (ND)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 332
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05402-0332
Mailing Address - Country:US
Mailing Address - Phone:802-735-5989
Mailing Address - Fax:
Practice Address - Street 1:11 ELMWOOD AVE # 332
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-4366
Practice Address - Country:US
Practice Address - Phone:802-735-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0093557175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1021745Medicaid