Individual
MR. SEAN T NIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C, MPAS
Contact information
Practice address
MADIGAN ARMY MEDICAL CENTER 9040 A JACKSON AVE, TACOMA, WA 98431-4334
(253) 968-6115
Mailing address
MADIGAN ARMY MEDICAL CENTER 9040 A JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MILITARY
—
363AM0700X
Medical Physician Assistant
Primary
PA-60561046
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA60561046
STATE PHYSICIAN ASSISTANT LICENSE
WA
Enumeration date
12/27/2006
Last updated
04/09/2019
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