Provider Demographics
NPI:1700987385
Name:NELSON, CLAVEL J (FNP)
Entity Type:Individual
Prefix:
First Name:CLAVEL
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CLAVEL
Other - Middle Name:J
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:322 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076-1128
Mailing Address - Country:US
Mailing Address - Phone:908-625-6846
Mailing Address - Fax:908-322-4564
Practice Address - Street 1:322 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1128
Practice Address - Country:US
Practice Address - Phone:908-625-6846
Practice Address - Fax:908-322-4564
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00029700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ107839XVAMedicare UPIN