Provider Demographics
NPI:1023249893
Name:NIELSEN, KRISTA MARIE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARIE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 E LELAND ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2021
Mailing Address - Country:US
Mailing Address - Phone:801-735-2805
Mailing Address - Fax:
Practice Address - Street 1:1676 E. MCMURRAY BLVD
Practice Address - Street 2:CGRMC URGENT CARE
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-316-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3403363LF0000X
UT57323284405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily