Provider Demographics
NPI:1629021043
Name:NELSON, MARCI M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCI
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:21911 76TH AVE W
Mailing Address - Street 2:#110
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7903
Mailing Address - Country:US
Mailing Address - Phone:425-640-4950
Mailing Address - Fax:425-640-4958
Practice Address - Street 1:21911 76TH AVE W
Practice Address - Street 2:#110
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7903
Practice Address - Country:US
Practice Address - Phone:425-640-4950
Practice Address - Fax:425-640-4958
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00042464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8393597Medicaid
WA4252PUOtherREGENCE BLUE SHIELD
WA8393597Medicaid
WA4252PUOtherREGENCE BLUE SHIELD