Provider Demographics
NPI:1043442700
Name:NELSEN, ANDREA J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:J
Last Name:NELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-0818
Mailing Address - Country:US
Mailing Address - Phone:808-885-5900
Mailing Address - Fax:808-885-6900
Practice Address - Street 1:64-1035 MAMALAHOA HWY STE F
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8440
Practice Address - Country:US
Practice Address - Phone:808-885-5900
Practice Address - Fax:808-885-6900
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN560982084P0800X, 2084P0800X
HIMD-242172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry