Provider Demographics
NPI:1285846220
Name:NELSON, MARY R (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PIRIE RD
Mailing Address - Street 2:STE D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3166
Mailing Address - Country:US
Mailing Address - Phone:805-649-5774
Mailing Address - Fax:
Practice Address - Street 1:117 PIRIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA449374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily