Provider Demographics
NPI:1073364865
Name:NELSON, IRENE (APRN)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:PAUL
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10424 BEAUTIFUL FRUIT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5222
Mailing Address - Country:US
Mailing Address - Phone:505-610-2319
Mailing Address - Fax:
Practice Address - Street 1:10424 BEAUTIFUL FRUIT ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-5222
Practice Address - Country:US
Practice Address - Phone:505-610-2319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV846041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health