Provider Demographics
NPI:1750369484
Name:NELSON, CHRISTINA MARJORIE (CFNP)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:MARJORIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6638 SAINT ESTABAN ST
Mailing Address - Street 2:
Mailing Address - City:TUJUNGA
Mailing Address - State:CA
Mailing Address - Zip Code:91042-3333
Mailing Address - Country:US
Mailing Address - Phone:818-353-6103
Mailing Address - Fax:
Practice Address - Street 1:6638 SAINT ESTABAN ST
Practice Address - Street 2:
Practice Address - City:TUJUNGA
Practice Address - State:CA
Practice Address - Zip Code:91042-3333
Practice Address - Country:US
Practice Address - Phone:818-353-6103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR16084363LF0000X
CA265149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4R1978Medicare UPIN