Provider Demographics
NPI:1225224819
Name:NELSON, VIERA (MD)
Entity Type:Individual
Prefix:
First Name:VIERA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840294
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0294
Mailing Address - Country:US
Mailing Address - Phone:888-344-1160
Mailing Address - Fax:972-331-3148
Practice Address - Street 1:4207 E COTTON CENTER BLVD.
Practice Address - Street 2:BUILDING 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040
Practice Address - Country:US
Practice Address - Phone:888-276-2223
Practice Address - Fax:972-767-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62316207ZH0000X
AZ44889207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44889OtherMD LICENSE