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DAVID E. NILSSON, PH.D., P.C.

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Company Details

Name: DAVID E. NILSSON, PH.D., P.C.
Jurisdiction: Idaho
Legal type: Professional Service Corporation (D)
Status: Inactive-Revoked (Administrative)
Date of registration: 20 Nov 2008 (17 years ago)
Financial Date End: 30 Nov 2014
Date dissolved: 10 Feb 2015
Entity Number: 547168
Place of Formation: UTAH
File Number: 0000547168
ZIP code: 83702
County: Ada County
Mailing Address: 950 W BANNOCK ST #1100 BOISE, ID 83702

National Provider Identifier

NPI Number:
1275891194

Authorized Person:

Name:
CINDY NILSSON
Role:
CLINIC DIRECTOR
Phone:

Taxonomy:

Selected Taxonomy:
103G00000X - Clinical Neuropsychologist
Is Primary:
Yes

Contacts:

Fax:
8883289210

Filing

Filing Name Filing Number Filing date
Legacy Amendment 0003177420 2014-10-15
Annual Report 0003177419 2013-09-27
Annual Report 0003177418 2012-09-25
Statement of Change of Business Mailing Address 0003177422 2012-06-25
Annual Report 0003177416 2011-11-17

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State