Individual
LISA K NIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7309 N KNOXVILLE AVE, PEORIA, IL 61614-2085
(309) 692-9898
(309) 692-9055
Mailing address
7309 N KNOXVILLE AVE, PEORIA, IL 61614-2085
(309) 692-9898
(309) 692-9055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
85000333
IL
Other
Enumeration date
12/06/2005
Last updated
02/25/2020
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