Provider Demographics
NPI:1508905647
Name:NELSON, MARY JANE (APRN BC RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JANE
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN BC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 N UTAH ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201
Mailing Address - Country:US
Mailing Address - Phone:703-528-4584
Mailing Address - Fax:
Practice Address - Street 1:1725 N GEORGE MASON DRIVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-228-5162
Practice Address - Fax:703-228-5234
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001136555364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult