Provider Demographics
NPI:1184406795
Name:NELSON, PARKER (RD)
Entity type:Individual
Prefix:
First Name:PARKER
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2562 WALNUT BLVD APT 94
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4250
Mailing Address - Country:US
Mailing Address - Phone:925-324-1785
Mailing Address - Fax:
Practice Address - Street 1:2562 WALNUT BLVD APT 94
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4250
Practice Address - Country:US
Practice Address - Phone:925-324-1785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered