Provider Demographics
NPI:1851327829
Name:NELSON, MARIETTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIETTA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 W CHARLESTON BLVD
Mailing Address - Street 2:#204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2023
Mailing Address - Country:US
Mailing Address - Phone:702-384-2020
Mailing Address - Fax:702-384-6371
Practice Address - Street 1:3100 W CHARLESTON BLVD
Practice Address - Street 2:#204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2023
Practice Address - Country:US
Practice Address - Phone:702-384-2020
Practice Address - Fax:702-384-6371
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5471207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002796Medicaid
NV002002796Medicaid
C67315Medicare UPIN