Provider Demographics
NPI:1134865207
Name:NELSON, MAUREEN MONROY (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MONROY
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:BELINDA
Other - Last Name:MONROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2125 E. THOUSAND OAKS BLVD, SUITE B-2
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2965
Mailing Address - Country:US
Mailing Address - Phone:805-374-7874
Mailing Address - Fax:805-374-7876
Practice Address - Street 1:2125 E. THOUSAND OAKS BLVD, SUITE B-2
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2965
Practice Address - Country:US
Practice Address - Phone:805-374-7874
Practice Address - Fax:805-374-7876
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4840364SP0200X
CA95012666363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics