Provider Demographics
NPI:1740967397
Name:NELSON, GRACE ELIZABETH-ANN
Entity type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ELIZABETH-ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E LINDSEY ST APT D
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-2274
Mailing Address - Country:US
Mailing Address - Phone:580-530-2127
Mailing Address - Fax:
Practice Address - Street 1:900 N PORTER AVE STE 110
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73071-6426
Practice Address - Country:US
Practice Address - Phone:405-914-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-04
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator