Provider Demographics
NPI:1396816625
Name:NELSON, NAN E (MD)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32145 SEDGEFIELD OVAL
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-4756
Mailing Address - Country:US
Mailing Address - Phone:330-557-0586
Mailing Address - Fax:
Practice Address - Street 1:32145 SEDGEFIELD OVAL
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-4756
Practice Address - Country:US
Practice Address - Phone:330-557-0586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350613132084P0800X
OH35.061313208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0972890Medicaid
E80017Medicare UPIN
0751865Medicare PIN
OH0972890Medicaid