Provider Demographics
NPI:1932645199
Name:NIELSEN, MARILYN LOUISE (FNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:LOUISE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 N STATE LINE AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5303
Mailing Address - Country:US
Mailing Address - Phone:903-794-7874
Mailing Address - Fax:903-794-0741
Practice Address - Street 1:5503 N STATE LINE AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5303
Practice Address - Country:US
Practice Address - Phone:903-794-7874
Practice Address - Fax:903-794-0741
Is Sole Proprietor?:No
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily