Provider Demographics
NPI:1487667499
Name:NELSON, ANGELA L (CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:ISENBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:6 NASTURTIUM TER
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-3427
Mailing Address - Country:US
Mailing Address - Phone:603-228-6534
Mailing Address - Fax:
Practice Address - Street 1:253 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7560
Practice Address - Country:US
Practice Address - Phone:603-226-6117
Practice Address - Fax:603-229-5492
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044077-23-01367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30341655Medicaid
P42182Medicare UPIN
NHRE6436Medicare ID - Type Unspecified