Individual
MR. BRUCE RODERICK NIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 NE 194TH ST, UNIT 1, RIDGEFIELD, WA 98642-9496
(360) 936-1096
(425) 216-9433
Mailing address
800 NE TENNEY RD, UNIT 110-401, VANCOUVER, WA 98685-2831
(425) 216-9433
(425) 216-9433
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
ST00001996
WA
247100000X
Radiologic Technologist
XT00004606
WA
247200000X
Other Technician
MA00153098
WA
376K00000X
Nurse's Aide
NA00153098
WA
Other
Enumeration date
01/30/2015
Last updated
01/30/2015
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