Provider Demographics
NPI:1245382027
Name:NELSON, NII OTABIL
Entity Type:Individual
Prefix:
First Name:NII
Middle Name:OTABIL
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:NII
Other - Middle Name:OTABIL
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD,LSA
Mailing Address - Street 1:10107 WESTVIEW DR
Mailing Address - Street 2:167
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4486
Mailing Address - Country:US
Mailing Address - Phone:281-220-7147
Mailing Address - Fax:281-220-7147
Practice Address - Street 1:10107 WESTVIEW DR
Practice Address - Street 2:167
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4486
Practice Address - Country:US
Practice Address - Phone:281-220-7147
Practice Address - Fax:281-220-7147
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9904L363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical