Provider Demographics
NPI:1184729857
Name:NELSON, LORRAINE K (MD)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:K
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 1:450 E YOSEMITE AVE
Mailing Address - Street 2:STE B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8429
Mailing Address - Country:US
Mailing Address - Phone:209-383-3152
Mailing Address - Fax:209-383-3137
Practice Address - Street 1:450 E YOSEMITE AVE
Practice Address - Street 2:STE B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8429
Practice Address - Country:US
Practice Address - Phone:209-383-3152
Practice Address - Fax:209-383-3137
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG39689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0094611Medicaid
CAGR0094611Medicaid
GR0094610Medicare ID - Type Unspecified