Individual
DR. MARY LYNN NIELSEN
Active
Individual
DR. MARY LYNN NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MDR7P10
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111963
BLUE CROSS
MO
01
—
11589908
CAQH
—
05
—
F31343
—
MO
Enumeration date
02/13/2007
Last updated
07/08/2007
Update your record
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