Individual
AUSTIN STANLEY NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5921 W STATE ROAD 46, BLOOMINGTON, IN 47404-9359
(812) 935-8866
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01087938A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2019
Last updated
07/19/2022
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