Provider Demographics
NPI:1245884642
Name:NIELSEN, SAMANTHA MARIE (RDN, LD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 RED CANON PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2323
Mailing Address - Country:US
Mailing Address - Phone:612-723-0735
Mailing Address - Fax:
Practice Address - Street 1:3718 RED CANON PL
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-2323
Practice Address - Country:US
Practice Address - Phone:612-723-0735
Practice Address - Fax:719-917-9303
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered