Provider Demographics
NPI:1346484920
Name:NELSEN, SUSAN PROCTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:PROCTOR
Last Name:NELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1050 BISHOP ST
Mailing Address - Street 2:#420
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4210
Mailing Address - Country:US
Mailing Address - Phone:808-927-6879
Mailing Address - Fax:844-838-8079
Practice Address - Street 1:1050 BISHOP ST
Practice Address - Street 2:#420
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4210
Practice Address - Country:US
Practice Address - Phone:808-927-6879
Practice Address - Fax:844-838-8079
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-41943207R00000X, 2084P0800X
HIMD-183642084P0800X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine