Provider Demographics
NPI:1790764603
Name:NELSON, YVONNE SUE (MD)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:SUE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28650 STATE HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1712
Mailing Address - Country:US
Mailing Address - Phone:607-652-2537
Mailing Address - Fax:607-652-2719
Practice Address - Street 1:28650 STATE HIGHWAY 23
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:NY
Practice Address - Zip Code:12167-1712
Practice Address - Country:US
Practice Address - Phone:607-652-2537
Practice Address - Fax:607-652-2719
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC286752083X0100X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080193481OtherRAILROAD MEDICARE
2787393OtherAETNA US HEALTHCARE
765229OtherAETNA HMO
B5214OtherMEDCOST
0929764001OtherCIGNA
800214OtherPARTNERS MEDICARE
8962117OtherMEDICAID
NC8962117Medicaid
62117OtherBCBS
080193481OtherRAILROAD MEDICARE
62117OtherBCBS