Provider Demographics
NPI:1992217277
Name:NELSON, GINA EILEEN
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:EILEEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 OAKDALE ST STE D
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2451
Mailing Address - Country:US
Mailing Address - Phone:916-496-7663
Mailing Address - Fax:
Practice Address - Street 1:555 OAKDALE ST STE D
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2451
Practice Address - Country:US
Practice Address - Phone:916-496-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty