Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 2305204696 | VA |
N | 2251G0304X | Physical Therapist - Geriatrics | 2305204696 | VA |
N | 2251S0007X | Physical Therapist - Sports | 2305204696 | VA |
N | 2251X0800X | Physical Therapist - Orthopedic | 2305204696 | VA |
NPI | 1366537219 |
---|---|
Provider Name | Dr. Michele Christine Nielsen |
First Address | Virginia Beach, VA 23454-2202 |
Second Address | Virginia Beach, VA 23454-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 15/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366537219 | MEDICARE RAILROAD (01) | |
192612 | ANTHEM (01) | VA |
541853904 | AETNA (01) | VA |
541853904 | COMMERCIAL (01) | VA |