Individual
DAVID E NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST FL 10, BOISE, ID 83712-6241
(208) 381-5500
(208) 381-2555
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1183
ID
363AS0400X
Surgical Physician Assistant
PA-1183
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100001760728
REGENCE BLUESHIELD OF IDAHO
ID
05
—
1124393939
—
ID
01
—
PA734
BLUE CROSS OF IDAHO
ID
Enumeration date
03/12/2012
Last updated
12/10/2025
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