Individual
MR. LEON R NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
220 W 2ND ST, GOODLAND, KS 67735-1602
(785) 890-3625
Mailing address
810 BEAVER DR, GOODLAND, KS 67735-9781
(785) 899-6368
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
54087
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100246240A
MEDICIAID PROVIDER #
KS
01
—
12116
BLUE SHIELD #
KS
Enumeration date
11/30/2006
Last updated
07/08/2007
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