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Individual

JAY WALTER NIELSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1900 INDIAN WOOD CIR, SUITE 100, MAUMEE, OH 43537-4033
(419) 897-6490
(419) 897-0544
Mailing address
1900 INDIAN WOOD CIR, SUITE 100, MAUMEE, OH 43537-4033
(419) 897-6490
(419) 897-0544

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-04-0332-N
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0419158
OH
Enumeration date
11/10/2006
Last updated
10/25/2007
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