Provider Demographics
NPI:1669471256
Name:NELSON, SUSAN ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ELLEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7436 BISHOP OTT DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-8931
Mailing Address - Country:US
Mailing Address - Phone:225-490-0604
Mailing Address - Fax:225-490-0354
Practice Address - Street 1:7436 BISHOP OTT DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-8931
Practice Address - Country:US
Practice Address - Phone:225-490-0604
Practice Address - Fax:225-490-0354
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10659R207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00106123OtherRAILROAD MEDICARE
LA1991597Medicaid
LA1991597Medicaid
LAC19830Medicare UPIN