Provider Demographics
NPI:1902371529
Name:NIELSEN, HALEY JO (RN)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:JO
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2117
Mailing Address - Country:US
Mailing Address - Phone:701-352-1760
Mailing Address - Fax:701-352-1761
Practice Address - Street 1:737 W 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2117
Practice Address - Country:US
Practice Address - Phone:701-352-1760
Practice Address - Fax:701-352-1761
Is Sole Proprietor?:No
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR35245163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse