Provider Demographics
NPI:1952865347
Name:NIELSEN, ANDREA (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 ANDOVER AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-3201
Mailing Address - Country:US
Mailing Address - Phone:307-760-9734
Mailing Address - Fax:
Practice Address - Street 1:5615 DEAUVILLE STE 220
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-2707
Practice Address - Country:US
Practice Address - Phone:432-686-0321
Practice Address - Fax:432-689-0718
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0201021062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer