Provider Demographics
NPI:1649307679
Name:NELSON, JOAN M (DNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 W OXFORD AVE
Mailing Address - Street 2:G3
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-3106
Mailing Address - Country:US
Mailing Address - Phone:303-797-4260
Mailing Address - Fax:
Practice Address - Street 1:3525 W OXFORD AVE
Practice Address - Street 2:G3
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-3106
Practice Address - Country:US
Practice Address - Phone:303-797-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO109709207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56102780Medicaid
COP00888727OtherRR MEDICARE PIN
013903OtherKAISER-COMMERCIAL NUMBER
013903OtherKAISER-COMMERCIAL NUMBER