Provider Demographics
NPI:1164763330
Name:NELSON, NATALIE R (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12331 WATERSTONE LN
Mailing Address - Street 2:APT 706
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3045
Mailing Address - Country:US
Mailing Address - Phone:775-220-7497
Mailing Address - Fax:
Practice Address - Street 1:1614 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3464
Practice Address - Country:US
Practice Address - Phone:419-385-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003729363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical