Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 35068827 | OH |
NPI | 1003803834 |
---|---|
Provider Name | Dr. Erik Wagner Nielsen |
First Address | Findlay, OH 45840-2423 |
Second Address | Findlay, OH 45840-2423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 17/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000283044 | BLUE CROSS BLUE SHIELD NO (01) | OH |
0159555 | (05) | OH |
B37170 | (02) | OH |