Provider Demographics
NPI:1245441716
Name:NELSON, KRISTIN SCHAD (DO)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SCHAD
Last Name:NELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1492 S MILL AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5652
Mailing Address - Country:US
Mailing Address - Phone:480-894-5550
Mailing Address - Fax:480-894-9469
Practice Address - Street 1:1492 S MILL AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5652
Practice Address - Country:US
Practice Address - Phone:480-894-5550
Practice Address - Fax:480-894-9469
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4044207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227443Medicaid