Provider Demographics
NPI:1982627485
Name:NELSEN, ELISE JANELL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:JANELL
Last Name:NELSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1819
Mailing Address - Country:US
Mailing Address - Phone:607-215-5159
Mailing Address - Fax:
Practice Address - Street 1:180 N ELMIRA ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1328
Practice Address - Country:US
Practice Address - Phone:607-215-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4659213E00000X
PASC006023213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020816460002Medicaid
NY03334296Medicaid
PA1020816460002Medicaid