Provider Demographics
NPI:1164441820
Name:NELSON, NANCY P (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:P
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 LILLY RD NE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5117
Mailing Address - Country:US
Mailing Address - Phone:360-459-5009
Mailing Address - Fax:360-459-8785
Practice Address - Street 1:615 LILLY RD NE
Practice Address - Street 2:SUITE 140
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5117
Practice Address - Country:US
Practice Address - Phone:360-459-5009
Practice Address - Fax:360-459-8785
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP345WAMedicaid
MT4301017Medicaid
WA9627829Medicaid
AB009967Medicare ID - Type Unspecified
AKNP345WAMedicaid