| Doctor Name: | MR. BRUCE RODERICK NIELSON |
| NPI Number: | 1043600836 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | XT00004606 |
| Business Practice Address: | 415 Ne 194th St Unit 1 Ridgefield, WA - 986429496 |
| Business Phone Number: | 3609361096 |
| Business Fax Number: | 4252169433 |
| Mailing Address: | 800 Ne Tenney Rd, Unit 110-401 VANCOUVER |
| State: | WA |
| Postal Code: | 986852831 |
| Phone Number: | 4252169433 |
| Fax Number: | 4252169433 |
| NPI Enumeration Date: | 01/30/2015 |
| NPI Last Update Date: | 01/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 247100000X |
| License Number: | XT00004606 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WA |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is trained and qualified in the art and science of both ionizing and non-ionizing radiation for the purposes of diagnostic medical imaging, interventional procedures and therapeutic treatment. |