Provider Demographics
NPI:1841281920
Name:NELSON, DONNA E
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:E
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:HHC 121 GH
Mailing Address - Street 2:BOX 472
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:KR
Mailing Address - Phone:0118226-371-1420
Mailing Address - Fax:
Practice Address - Street 1:18TH MEDCOM
Practice Address - Street 2:ATTN: DCCS-QM (CREDENTIALS)
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96205-0054
Practice Address - Country:KR
Practice Address - Phone:0118227-916-6027
Practice Address - Fax:0118227-917-8110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN268394171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor