Individual
MS. TANYA MCCREA NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCCA
Contact information
Practice address
2521 GLENN HENDREN DR STE 104, LIBERTY, MO 64068-3388
(816) 781-6066
(816) 792-0408
Mailing address
PO BOX 219672, KANSAS CITY, MO 64121-9672
(816) 407-4200
(816) 407-2362
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
051
NE
231H00000X
Audiologist
Primary
2019044094
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025369400
—
NE
01
—
2019044094
MISSOURI LICENSE
MO
Enumeration date
05/23/2008
Last updated
11/26/2019
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