Provider Demographics
NPI:1265564835
Name:NIELSEN, DONALD P (ATC)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:P
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1466
Mailing Address - Country:US
Mailing Address - Phone:630-232-8263
Mailing Address - Fax:
Practice Address - Street 1:1020 DUNHAM ROAD
Practice Address - Street 2:ST. CHARLES EAST HIGH SCHOOL
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174
Practice Address - Country:US
Practice Address - Phone:331-228-4339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960000292255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer