Individual
DR. MARY LYNN NIELSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
225 S MERAMEC AVE, SUITE 932T, CLAYTON, MO 63105-3511
(314) 721-7550
(314) 863-2114
Mailing address
225 S MERAMEC AVE, SUITE 932T, CLAYTON, MO 63105-3511
(314) 721-7550
(314) 863-2114
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
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