Provider Demographics
NPI:1114673340
Name:NELSON, ERIN MAE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3125
Mailing Address - Country:US
Mailing Address - Phone:857-998-1516
Mailing Address - Fax:
Practice Address - Street 1:149 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3564
Practice Address - Country:US
Practice Address - Phone:978-774-7570
Practice Address - Fax:978-777-8547
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist