Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 00165 | KY |
NPI | 1174521082 |
---|---|
Provider Name | William M Nielson |
First Address | Cincinnati, OH 45263-5283 |
Second Address | Florence, KY 41042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000032629 | ANTHEM (01) | KY |
27-00334 | UHC (01) | KY |
4393890 | AETNA (01) | KY |
80001654 | (05) | KY |
90040080 | (05) | KY |
T53939 | (02) | KY |