Provider Demographics
NPI:1649832049
Name:NIELSEN, COSETTE MARIE
Entity type:Individual
Prefix:
First Name:COSETTE
Middle Name:MARIE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KING COVE
Mailing Address - State:AK
Mailing Address - Zip Code:99612-0009
Mailing Address - Country:US
Mailing Address - Phone:907-497-2311
Mailing Address - Fax:907-497-2310
Practice Address - Street 1:100 SLOCUM DRIVE
Practice Address - Street 2:
Practice Address - City:KING COVE
Practice Address - State:AK
Practice Address - Zip Code:99612-9961
Practice Address - Country:US
Practice Address - Phone:907-497-2311
Practice Address - Fax:907-497-2311
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program