Provider Demographics
NPI:1801160072
Name:NELSON, AMY BETH (LPN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BETHEL DR APT 2
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-2594
Mailing Address - Country:US
Mailing Address - Phone:541-653-5183
Mailing Address - Fax:
Practice Address - Street 1:305 BETHEL DR APT 2
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-2594
Practice Address - Country:US
Practice Address - Phone:541-653-5183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030317LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse