Provider Demographics
NPI:1750912754
Name:NELSON, MARIE SONIE (PA, MD)
Entity type:Individual
Prefix:
First Name:MARIE SONIE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GUILD RD
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3224
Mailing Address - Country:US
Mailing Address - Phone:774-296-8859
Mailing Address - Fax:
Practice Address - Street 1:31 GUILD RD
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3224
Practice Address - Country:US
Practice Address - Phone:774-296-8859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPA622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant