Provider Demographics
NPI:1063061273
Name:NIELSON, HEIDI (BA, ABAT, JDC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:NIELSON
Suffix:
Gender:F
Credentials:BA, ABAT, JDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 W MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1729
Mailing Address - Country:US
Mailing Address - Phone:760-745-0778
Mailing Address - Fax:
Practice Address - Street 1:337 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1729
Practice Address - Country:US
Practice Address - Phone:760-745-0778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker