Individual
JUSTIN S. NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2985 CORTEZ AVE, IDAHO FALLS, ID 83404-7554
(208) 523-3373
(208) 523-8746
Mailing address
2985 CORTEZ AVE, IDAHO FALLS, ID 83404-7554
(208) 523-3373
(208) 523-8746
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
002097
IA
363A00000X
Physician Assistant
Primary
PA-1255
ID
Other
Enumeration date
08/03/2010
Last updated
03/17/2017
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