Provider Demographics
NPI:1497061261
Name:NELSON, TRISHA L (CNP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 EASTERN AVE.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2709
Mailing Address - Country:US
Mailing Address - Phone:563-355-1853
Mailing Address - Fax:563-359-1512
Practice Address - Street 1:5350 EASTERN AVE.
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2709
Practice Address - Country:US
Practice Address - Phone:563-355-1853
Practice Address - Fax:563-359-1519
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008129363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008129OtherLICENSE
IL209008129OtherLICENSE