Provider Demographics
NPI:1760474225
Name:NELSON, GEORGE IRA JR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:IRA
Last Name:NELSON
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35 ALBANY RD
Mailing Address - Street 2:STE C
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7647
Mailing Address - Country:US
Mailing Address - Phone:337-238-5381
Mailing Address - Fax:
Practice Address - Street 1:133 ANGELINA LN
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2570
Practice Address - Country:US
Practice Address - Phone:337-238-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN066085367500000X
IL209008541367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered