Provider Demographics
NPI:1477369510
Name:NIELSEN, ARYON MICHELLE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ARYON
Middle Name:MICHELLE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-8479
Mailing Address - Country:US
Mailing Address - Phone:253-227-0379
Mailing Address - Fax:
Practice Address - Street 1:5055 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8479
Practice Address - Country:US
Practice Address - Phone:253-227-0379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65408363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical