Provider Demographics
NPI:1306226436
Name:NELSON, MAJA
Entity Type:Individual
Prefix:
First Name:MAJA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19045 STATE HIGHWAY 305 NE
Mailing Address - Street 2:STE 190
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7311
Mailing Address - Country:US
Mailing Address - Phone:360-697-6100
Mailing Address - Fax:360-697-4500
Practice Address - Street 1:19045 STATE HIGHWAY 305 NE
Practice Address - Street 2:STE 190
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7311
Practice Address - Country:US
Practice Address - Phone:360-697-6100
Practice Address - Fax:360-697-4500
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60530424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist