Provider Demographics
NPI:1588692255
Name:NIELSEN, PATRICIA DEYOUNG (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:DEYOUNG
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-662-9300
Mailing Address - Fax:910-662-2401
Practice Address - Street 1:2150 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-8052
Practice Address - Country:US
Practice Address - Phone:910-667-9402
Practice Address - Fax:877-665-4450
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP17942Medicare UPIN
NC7000389Medicaid
NC2599306BMedicare ID - Type Unspecified