Individual
TY NIELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4425 E AGAVE RD STE 148, PHOENIX, AZ 85044-0623
(480) 704-7546
Mailing address
4425 E AGAVE RD STE 148, PHOENIX, AZ 85044-0623
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
04/06/2015
Last updated
08/21/2017
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