Provider Demographics
NPI:1144261025
Name:NILSEN, STEPHANIE MARIE (PHD)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:NILSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 UNIVERSITY DR
Mailing Address - Street 2:STE D
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6206
Mailing Address - Country:US
Mailing Address - Phone:919-493-0011
Mailing Address - Fax:
Practice Address - Street 1:3805 UNIVERSITY DR
Practice Address - Street 2:STE D
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6206
Practice Address - Country:US
Practice Address - Phone:919-493-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2492637Medicare ID - Type Unspecified