Provider Demographics
NPI:1457844912
Name:NELSON, AVERY NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:NICOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-0810
Mailing Address - Country:US
Mailing Address - Phone:603-308-1472
Mailing Address - Fax:
Practice Address - Street 1:580 COURT ST
Practice Address - Street 2:NORTH BUILDING, LEVEL 1A
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-5496
Practice Address - Fax:603-354-5498
Is Sole Proprietor?:No
Enumeration Date:2018-06-10
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.072607207Y00000X
NH24202207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH24202OtherSTATE OF NEW HAMPSHIRE BOARD OF MEDICINE
IL125.072607OtherILLINOIS DEPARTMENT OF FINANCIAL & PROFESSIONAL REGULATION