Provider Demographics
NPI:1932178175
Name:NIELSEN, CAI ERIK (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CAI
Middle Name:ERIK
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 EUREKA ST
Mailing Address - Street 2:STE B
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5880
Mailing Address - Country:US
Mailing Address - Phone:817-598-9328
Mailing Address - Fax:817-599-4902
Practice Address - Street 1:713 E ANDERSON ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5705
Practice Address - Country:US
Practice Address - Phone:682-582-1000
Practice Address - Fax:817-599-4902
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANA3053367500000X
CARN545910367500000X
CACRNA3053367500000X
TX702217367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN5459100Medicaid
TX165014504Medicaid