Provider Demographics
NPI:1356736995
Name:NIELSEN, AMY K (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-233-4190
Mailing Address - Fax:906-789-3479
Practice Address - Street 1:2525 5TH AVE S
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-233-4190
Practice Address - Fax:906-789-3479
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101025626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356736995Medicaid