Provider Demographics
NPI:1497921811
Name:NELSON, KATHARINE SUE (MD)
Entity Type:Individual
Prefix:
First Name:KATHARINE
Middle Name:SUE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHARINE
Other - Middle Name:
Other - Last Name:WACHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 BELLEROSE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1729
Mailing Address - Country:US
Mailing Address - Phone:408-286-1707
Mailing Address - Fax:408-286-1744
Practice Address - Street 1:130 BELLEROSE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1729
Practice Address - Country:US
Practice Address - Phone:408-286-1707
Practice Address - Fax:408-286-1744
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108809207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology