Provider Demographics
NPI:1568524247
Name:NELSON, LISA INGRID (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:INGRID
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:INGRID
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1270 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3531
Mailing Address - Country:US
Mailing Address - Phone:415-353-2535
Mailing Address - Fax:415-353-2406
Practice Address - Street 1:400 PARNASSUS AVE
Practice Address - Street 2:4TH FLOOR, BOX 0378
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2535
Practice Address - Fax:415-353-2406
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10668363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ39085Medicare UPIN