Provider Demographics
NPI:1023010519
Name:NELSON, ANNE M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4920
Mailing Address - Country:US
Mailing Address - Phone:515-222-1111
Mailing Address - Fax:515-244-9914
Practice Address - Street 1:2000 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4920
Practice Address - Country:US
Practice Address - Phone:515-222-1111
Practice Address - Fax:515-244-9914
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001599363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14081Medicare ID - Type Unspecified
Q28735Medicare UPIN