Provider Demographics
NPI:1457743965
Name:NIELSEN, KIMBERLY JANE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JANE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-8820
Mailing Address - Country:US
Mailing Address - Phone:608-837-2867
Mailing Address - Fax:608-825-8561
Practice Address - Street 1:2538 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-8820
Practice Address - Country:US
Practice Address - Phone:608-837-2867
Practice Address - Fax:608-825-8561
Is Sole Proprietor?:No
Enumeration Date:2015-02-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12503183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist