Organization
J PAUL WIESNER & ASSOCIATES CHARTERED
Active
Other names
Radiology Associates of Nevada
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH K NIELSEN M.D. (PRESIDENT)
(702) 477-0772
Entity
Organization
Contact information
Practice address
5495 S RAINBOW BLVD STE 203, LAS VEGAS, NV 89118-1873
(702) 477-0772
Mailing address
PO BOX 30077, DEPT 305, SALT LAKE CITY, UT 84130-0077
(855) 865-4435
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200290100
—
NV
01
—
NV4864
BCBS NV
NV
Enumeration date
05/16/2006
Last updated
06/28/2023
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