Provider Demographics
NPI:1730152984
Name:NIELSEN, MARK ANDREW (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:NIELSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 W FRANCIS ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-0620
Mailing Address - Country:US
Mailing Address - Phone:308-534-2532
Mailing Address - Fax:308-534-6615
Practice Address - Street 1:611 W FRANCIS ST
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-0620
Practice Address - Country:US
Practice Address - Phone:308-534-2532
Practice Address - Fax:308-534-6615
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEC51990Medicare UPIN
NE274979Medicare ID - Type Unspecified