Individual
DOMINIC LEE VAN NIELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19200 N KELSEY ST, MONROE, WA 98272-1431
(425) 339-2433
(425) 339-8237
Mailing address
1100 PACIFIC AVE STE 300, EVERETT, WA 98201-4261
(425) 339-2433
(425) 339-8273
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
D94626
MD
207X00000X
Orthopaedic Surgery Physician
Primary
MD61002589
WA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
MD61002589
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2249981
—
WA
01
—
466835
WA L&I
WA
Enumeration date
03/29/2012
Last updated
08/31/2023
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