Provider Demographics
NPI:1750688263
Name:NELSON, ANNA DORA
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:DORA
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N TYLER CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-9246
Mailing Address - Country:US
Mailing Address - Phone:503-857-5919
Mailing Address - Fax:
Practice Address - Street 1:1216 N TYLER CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:OR
Practice Address - Zip Code:97127-9246
Practice Address - Country:US
Practice Address - Phone:503-857-5919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health