Provider Demographics
NPI:1205027430
Name:NELSON, JANIS ANNE (LM, CPM, RM)
Entity Type:Individual
Prefix:
First Name:JANIS
Middle Name:ANNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LM, CPM, RM
Other - Prefix:
Other - First Name:JUANITA
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LM, CPM, RM
Mailing Address - Street 1:755 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5498
Mailing Address - Country:US
Mailing Address - Phone:970-385-2626
Mailing Address - Fax:970-375-9053
Practice Address - Street 1:755 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5498
Practice Address - Country:US
Practice Address - Phone:970-385-2626
Practice Address - Fax:970-375-9053
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84100-R176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife