Individual
TARA DANIELLE NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC, APNP
Contact information
Practice address
2542 WYNFIELD DRIVE, RACINE, WI 53406-1897
(262) 880-5359
Mailing address
3710 57TH AVE, KENOSHA, WI 53144-4820
(262) 880-5359
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5430-33
WI
Other
Enumeration date
10/03/2013
Last updated
10/19/2016
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