Bruce Roderick Nielson

Primary specialty

Surgical TechnologistTaxonomy code 246ZS0410X

License

ST00001996 Issued in WA

Practice address

415 NE 194TH St
Unit 1
Ridgefield, WA 98642-9496

Phone

(360) 936-1096

Fax

(425) 216-9433

NPI assigned

Jan 30, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422576000000",
    "number": "1043600836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 NE TENNEY RD",
            "address_2": "UNIT 110-401",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986852831",
            "telephone_number": "425-216-9433",
            "fax_number": "425-216-9433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 NE 194TH ST",
            "address_2": "UNIT 1",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986429496",
            "telephone_number": "360-936-1096",
            "fax_number": "425-216-9433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "BRUCE",
        "middle_name": "RODERICK",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-01-30",
        "last_updated": "2015-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "WA",
            "license": "ST00001996",
            "primary": true
        },
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "WA",
            "license": "XT00004606",
            "primary": false
        },
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "WA",
            "license": "MA00153098",
            "primary": false
        },
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "WA",
            "license": "NA00153098",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgical Technologist in Ridgefield, WA
• Providers in Ridgefield, WA by specialty
• Surgical Technologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.