Provider Demographics
NPI:1083766760
Name:NELSON, NORMA A (MED)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 W CAMINO CERRO
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6207
Mailing Address - Country:US
Mailing Address - Phone:928-329-6332
Mailing Address - Fax:928-341-1700
Practice Address - Street 1:450 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2242
Practice Address - Country:US
Practice Address - Phone:928-341-1600
Practice Address - Fax:928-341-1700
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool