Provider Demographics
NPI:1891831053
Name:NIELSEN, KIRSTEN M (MD)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:M
Last Name:NIELSEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-463-5600
Mailing Address - Fax:
Practice Address - Street 1:1707 COLE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3255
Practice Address - Country:US
Practice Address - Phone:303-716-8027
Practice Address - Fax:303-238-5258
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO484902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42481287Medicaid
COCOA101516Medicare PIN