Provider Demographics
NPI:1154670412
Name:NELSON, MARIE Y (NP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:Y
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08232-3618
Mailing Address - Country:US
Mailing Address - Phone:609-445-4926
Mailing Address - Fax:609-380-4795
Practice Address - Street 1:912 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3618
Practice Address - Country:US
Practice Address - Phone:609-445-4926
Practice Address - Fax:609-380-4795
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00393400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily