Provider Demographics
NPI:1801849005
Name:NELSON, DOLORES A (CNP)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36001 EUCLID AVE
Mailing Address - Street 2:SUITE C-17
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4643
Mailing Address - Country:US
Mailing Address - Phone:440-946-4662
Mailing Address - Fax:440-946-4084
Practice Address - Street 1:36001 EUCLID AVE
Practice Address - Street 2:SUITE C-17
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4643
Practice Address - Country:US
Practice Address - Phone:440-946-4662
Practice Address - Fax:440-946-4084
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP03177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000526664OtherANTHEM BLUE SHIELD
OH2411107Medicaid
OH000000526664OtherANTHEM BLUE SHIELD
OHNP14693Medicare PIN
OHP00461248Medicare PIN
OH2411107Medicaid