Provider Demographics
NPI:1700841699
Name:NIELSEN, TERRI THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:THOMAS
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:9 CREST RD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-527-0753
Practice Address - Fax:802-524-2695
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0010564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1009698Medicaid
VTVN318101OtherMEDICARE ID TYPE UNSPECIFIED
VTVN318101OtherMEDICARE ID TYPE UNSPECIFIED