Provider Demographics
NPI:1336497783
Name:NELSON, ANDREA E (MR ARRT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:MR ARRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 E RACE AVE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4725
Mailing Address - Country:US
Mailing Address - Phone:501-368-0657
Mailing Address - Fax:501-368-0658
Practice Address - Street 1:2019 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4725
Practice Address - Country:US
Practice Address - Phone:501-368-0657
Practice Address - Fax:501-368-0658
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4777052471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging