Nielsen, Diane Rae

Nielsen, Diane Rae is an individual health care provider with primary practice located at 3430 Washington Parkway , Idaho Falls ID 83404. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Nielsen, Diane Rae can be contacted via phone (208) 523-3060.

Contact Information

Primary practice address
3430 Washington Parkway Idaho Falls ID 83404
Phone: (208) 523-3060
Fax: (208) 523-0028
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X PA178 Idaho

Profile Details

NPI number 1205940962
LBN Legal business name Nielsen, Diane Rae
Credentials PA C
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 19th, 2006
Last updated Sep 10th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205940962 NPPES
Idaho Other PAKY2 BLUE CROSS
Idaho MEDICAID 004378700 BLUE CROSS
Idaho Other 000010016257 BLUE CROSS

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