DAVID E. NILSSON, PH.D., P.C. (NPI# 1275891194) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275891194 |
| Entity Type | Organization |
| Organization Name | DAVID E. NILSSON, PH.D., P.C. |
| Other Organization Name | THE NEURODEVELOPMENT RESOURCE CENTER |
| Practice Address |
950 W Bannock St Ste 1100 Boise ID 83702-6140 |
| Practice Telephone | 2089475368 |
| Practice Fax Number | 8883289210 |
| Mailing Telephone | 2089475368 |
| Mailing Fax Number | 8883289210 |
| Enumeration Date | 2012-04-28 |
| Last Update Date | 2012-04-28 |
| Authorized Official Name | CINDY NILSSON (CLINIC DIRECTOR) |
| Authorized Official Telephone | 2089475368 |
| Authorized Official Credential | PT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103G00000X | Clinical Neuropsychologist | PSY-230 | ID | Behavioral Health & Social Service Providers |
| Other Name | Type Code |
|---|---|
| The NeuroDevelopment Resource Center | Doing Business As Name - Organization |
| Street Address |
950 W BANNOCK ST STE 1100 |
| City | BOISE |
| State | ID |
| Zip Code | 83702-6140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649597055 | Alex Brent Wills | Psychiatry & Neurology | 950 W Bannock St Ste 1100, Boise, ID 83702-6140 | 2010-04-24 |
| 1568938835 | William Tyler Steers | Nurse Practitioner | 950 W Bannock St Ste 1100, Boise, ID 83702-6140 | 2018-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790321966 | Inland Northwest Neuromonitoring Pllc | Psychiatry & Neurology | 950 Bannock Street, Suite 1100, Boise, ID 83702 | 2019-11-22 |
| 1508359084 | Emily Cook | Dietitian, Registered | St. Luke's Rehab Hospital, 600 N Robbins Road, Bosie, ID 83702 | 2018-06-11 |
| 1265925887 | Marla Braendle | Dietitian, Registered | St. Luke's Rehabilitation Hospital, 600 N. Robbins Road, Boise, ID 83702 | 2018-06-08 |
| 1114419678 | Sidrah Khan Psychotherapy PC | Social Worker | 242 N 8th St, Suite 200, Boise, ID 83702 | 2018-05-31 |
| 1508386707 | Emp Idaho Nampa, LLC | General Acute Care Hospital | 350 E Myrtle Street, Suite 100, Boise, ID 83702 | 2017-06-20 |
| 1194264077 | Karen Mangum | Dietitian, Registered | 115 N. Main Street, Suite #203, Boise, ID 83702 | 2017-02-13 |
| 1750828422 | Stephen Pyper | Massage Therapist | 14089 Main St #100, Boise, ID 83702 | 2017-01-19 |
| 1427504398 | The Young Mens Christian Association of Boise City Idaho | Health Educator | 419 N 11th St, Boise, ID 83702 | 2016-08-30 |
| 1942756838 | Brent Hiroshi Sasaki | Pharmacist | 500 West Fort Street (119), Boise, ID 83702 | 2016-08-30 |
| 1578912051 | Marnae Walker | Counselor | 509 S. 14th St, Suite 2, Boise, ID 83702 | 2016-06-06 |
| Find all providers in zip 83702 | ||||
| Taxonomy Code | 103G00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Clinical Neuropsychologist |
| An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |
| Notes: Source: American Psychological Association, Washington, DC, 1997. [1/1/2007: title modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295954485 | Saint Alphonsus Regional Medical Center Inc | Clinical Neuropsychologist | 717 N Liberty St, Boise, ID 83704-9342 | 2007-04-25 |
| 1952443640 | Christine Pickford | Clinical Neuropsychologist | 1104 N 18th St, Boise, ID 83702-3321 | 2007-02-12 |
| 1225176498 | Craig W. Beaver | Clinical Neuropsychologist | 250 Bobwhite Ct Ste 220, Boise, ID 83706-3983 | 2007-02-01 |
| 1326008053 | David E Nilsson | Clinical Neuropsychologist | 2537 W. State St., Suite 210, Boise, ID 83702 | 2006-03-25 |
| 1790241404 | Boise Brain Health | Clinical Neuropsychologist | 4696 W Overland Rd Ste 228, Boise, ID 83705-2864 | 2019-02-18 |
| 1215305263 | Cynthia Tremblay | Clinical Neuropsychologist | 600 N Robbins Rd, Boise, ID 83702-4565 | 2015-09-08 |
| 1154665123 | Merry Sylvester | Clinical Neuropsychologist | 1055 N Curtis Rd, Boise, ID 83706-1309 | 2012-11-15 |
| 1659631562 | Brienne M Dyer | Clinical Neuropsychologist | 500 W Fort St, (b114), Boise, ID 83702-4501 | 2012-05-24 |
| 1316241417 | Jeff Alan Sordahl Jr. | Clinical Neuropsychologist | 500 W Fort St, Boise, ID 83702-4501 | 2011-01-04 |
| 1265677298 | Amy E. Latta, Ph.d., P.a. | Clinical Neuropsychologist | 1020 W Main St, Suite 100b, Boise, ID 83702-5789 | 2008-12-04 |
| Find all providers in BOISE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.