Provider Demographics
NPI:1275717183
Name:NELSON, MALINA AMBER (RN)
Entity Type:Individual
Prefix:MS
First Name:MALINA
Middle Name:AMBER
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 E 121ST AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3595
Mailing Address - Country:US
Mailing Address - Phone:720-404-5306
Mailing Address - Fax:
Practice Address - Street 1:10065 E HARVARD AVE STE 400
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5943
Practice Address - Country:US
Practice Address - Phone:303-614-1536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167843163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse