Provider Demographics
NPI:1255694642
Name:NELSON, ANNA CECELIA (FNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CECELIA
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-6304
Mailing Address - Country:US
Mailing Address - Phone:315-235-2540
Mailing Address - Fax:315-235-2171
Practice Address - Street 1:125 BUSINESS PARK DR
Practice Address - Street 2:SUITE 150
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-6304
Practice Address - Country:US
Practice Address - Phone:315-235-2540
Practice Address - Fax:315-235-2171
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334324-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily