Provider Demographics
NPI:1831274760
Name:NELSON, NANCY (CNM, ANP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNM, ANP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM, ANP
Mailing Address - Street 1:36121 MAYONI STREET
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-4267
Mailing Address - Country:US
Mailing Address - Phone:907-260-9027
Mailing Address - Fax:907-260-6905
Practice Address - Street 1:36121 MAYONI ST.
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-4267
Practice Address - Country:US
Practice Address - Phone:907-260-9027
Practice Address - Fax:907-260-6905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK438367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP04382Medicaid
AKNP04382Medicaid