Provider Demographics
NPI:1841244787
Name:NIELSEN, JEFFREY WINTHER (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:WINTHER
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37938
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28237-7938
Mailing Address - Country:US
Mailing Address - Phone:704-332-0366
Mailing Address - Fax:704-971-0035
Practice Address - Street 1:9800 KINCEY AVE STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8405
Practice Address - Country:US
Practice Address - Phone:704-799-4909
Practice Address - Fax:704-971-0035
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCNC33413207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127R1Medicaid
NC89127R1Medicaid
NC2150767FMedicare PIN
NC89127R1Medicaid