Provider Demographics
NPI:1801836101
Name:NELSON, JOHN EDWARD
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 19TH ST
Mailing Address - Street 2:#12
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-2047
Mailing Address - Country:US
Mailing Address - Phone:409-766-4776
Mailing Address - Fax:409-766-4765
Practice Address - Street 1:US COAST GUARD SFO GALVESTON #1 FERRY ROAD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77553
Practice Address - Country:US
Practice Address - Phone:409-766-4776
Practice Address - Fax:409-766-4765
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other