Provider Demographics
NPI:1295025757
Name:NELSON, MICHELLE MARI (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MARI
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 PARKLANEDR
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068
Mailing Address - Country:US
Mailing Address - Phone:505-307-3574
Mailing Address - Fax:
Practice Address - Street 1:2720 PARKLANE DR
Practice Address - Street 2:
Practice Address - City:BOSQUE FARMS
Practice Address - State:NM
Practice Address - Zip Code:87068
Practice Address - Country:US
Practice Address - Phone:505-307-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-07244104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker