Provider Demographics
NPI:1205118668
Name:NELSON, BARTHOLOMEW (NP)
Entity type:Individual
Prefix:
First Name:BARTHOLOMEW
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HARVARD RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2434
Mailing Address - Country:US
Mailing Address - Phone:978-514-6500
Mailing Address - Fax:
Practice Address - Street 1:1 HARVARD RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2434
Practice Address - Country:US
Practice Address - Phone:978-514-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2264401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily