Provider Demographics
NPI:1467502112
Name:NELSON, DWAYNE ALAN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:ALAN
Last Name:NELSON
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
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Mailing Address - Street 1:AID STATION BLDG 87008
Mailing Address - Street 2:1ST SQDN, 3D ACR
Mailing Address - City:FT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:630-991-0690
Mailing Address - Fax:
Practice Address - Street 1:AID STATION BLDG 87008
Practice Address - Street 2:1ST SQDN, 3D ACR
Practice Address - City:FT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:630-991-0690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant