Individual
DR. NATHANIEL RICHARD NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
7080 W SANNA ST, PEORIA, AZ 85345-8898
(208) 406-6573
Mailing address
7080 W SANNA ST, PEORIA, AZ 85345-8898
(208) 406-6573
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002514
AZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/26/2021
Last updated
08/05/2021
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