Provider Demographics
NPI:1235477381
Name:NELSON, RICHARD ARTHUR
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:A
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6 HATHAWAY CRES
Mailing Address - Street 2:
Mailing Address - City:SUGAR GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60554-4137
Mailing Address - Country:US
Mailing Address - Phone:630-466-4630
Mailing Address - Fax:
Practice Address - Street 1:6 HATHAWAY CRES
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-4137
Practice Address - Country:US
Practice Address - Phone:630-466-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360481942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology