Provider Demographics
NPI:1407415649
Name:NELSON, ELISE MARIE (AGNP-C)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:
Other - Last Name:COMPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 HOSPICE LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5766
Mailing Address - Country:US
Mailing Address - Phone:336-768-3972
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPICE LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5766
Practice Address - Country:US
Practice Address - Phone:336-768-3972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner