Provider Demographics
NPI:1811957103
Name:NIELSEN, PATRICIA C (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:C
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-722-1818
Mailing Address - Fax:336-722-1826
Practice Address - Street 1:2001 TODAYS WOMAN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-5069
Practice Address - Country:US
Practice Address - Phone:336-722-1818
Practice Address - Fax:336-722-1826
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC000940056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003684Medicaid
NC2806640BMedicare PIN
P61019Medicare UPIN