Basic Information
| Provider Information | |||||||||
| NPI: | 1932794310 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIELSEN | ||||||||
| FirstName: | STACEA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 4TH ST | ||||||||
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| City: | CAMANCHE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527302119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632493217 | ||||||||
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| Practice Location | |||||||||
| Address1: | 849 13TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527325168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5632421521 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2021 | ||||||||
| LastUpdateDate: | 03/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 106352 | IA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.