Provider Demographics
NPI:1770119570
Name:NIELSEN, LINDSEY MARIE (RN)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:RN
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 404
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:WI
Mailing Address - Zip Code:53079-0404
Mailing Address - Country:US
Mailing Address - Phone:920-382-8637
Mailing Address - Fax:
Practice Address - Street 1:904 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:WI
Practice Address - Zip Code:53079-2003
Practice Address - Country:US
Practice Address - Phone:920-382-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty