Provider Demographics
NPI:1558448860
Name:NELSON, LISA T (MS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:T
Last Name:NELSON
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Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:34811 MELTON ST
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4469
Mailing Address - Country:US
Mailing Address - Phone:734-728-9532
Mailing Address - Fax:734-728-9532
Practice Address - Street 1:13322 CONANT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-2338
Practice Address - Country:US
Practice Address - Phone:313-366-9050
Practice Address - Fax:313-366-3809
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI5601002707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant