Provider Demographics
NPI:1497041396
Name:NIELSEN, NATHAN SCOTT (DO)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SCOTT
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 ASHBURN ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79906-4001
Mailing Address - Country:US
Mailing Address - Phone:702-630-2463
Mailing Address - Fax:
Practice Address - Street 1:4747 ASHBURN ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79906-4001
Practice Address - Country:US
Practice Address - Phone:702-630-2463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-14682085R0204X
TXS43572085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN