Provider Demographics
NPI:1891825311
Name:NIELSEN, CINDY ELAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:ELAINE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342-1505
Mailing Address - Country:US
Mailing Address - Phone:641-484-4094
Mailing Address - Fax:
Practice Address - Street 1:1646 305TH ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9634
Practice Address - Country:US
Practice Address - Phone:641-484-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA76883207Q00000X
IA01964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ490244Medicaid
8EZ05RMedicare ID - Type UnspecifiedMEDICARE PART B #
8EZ02RMedicare ID - Type UnspecifiedMEDICARE PART B #
8EZ98PMedicare ID - Type UnspecifiedMEDICARE PART B #
8EZ99PMedicare ID - Type UnspecifiedMEDICARE PART B #
AZ490244Medicaid
8EZ03RMedicare ID - Type UnspecifiedMEDICARE PART B #