1700173192 NPI number — DR. HEIDI M NELSON DPT

Table of content: DR. HEIDI M NELSON DPT (NPI 1700173192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700173192 NPI number — DR. HEIDI M NELSON DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
HEIDI
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700173192
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 COURTYARD DR
Provider Second Line Business Mailing Address:
APT 216
Provider Business Mailing Address City Name:
DAKOTA DUNES
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57049-5221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-293-0000
Provider Business Mailing Address Fax Number:
712-279-5486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2538 GLENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIOUX CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
51106-2768
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
712-226-2253
Provider Business Practice Location Address Fax Number:
712-226-2257
Provider Enumeration Date:
07/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  3005 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10025287200 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com