Provider Demographics
NPI:1982868667
Name:NIELSON, CODY MONCUR (APRN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CODY
Middle Name:MONCUR
Last Name:NIELSON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 753
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82440-0753
Mailing Address - Country:US
Mailing Address - Phone:307-754-8108
Mailing Address - Fax:
Practice Address - Street 1:720 LINDSAY LN
Practice Address - Street 2:SUITE A
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4103
Practice Address - Country:US
Practice Address - Phone:307-578-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2177707-4405363LF0000X
WY22181.1080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily