Provider Demographics
NPI:1952525396
Name:NELSON, COLETTE (NP)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 3RD AVE APT 8D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2510
Mailing Address - Country:US
Mailing Address - Phone:917-545-0200
Mailing Address - Fax:212-937-3325
Practice Address - Street 1:236 E 28TH ST
Practice Address - Street 2:APT 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8513
Practice Address - Country:US
Practice Address - Phone:917-545-0200
Practice Address - Fax:212-937-3325
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY847969133V00000X
133V00000X
MI4704380646163W00000X, 363LF0000X
NY82438701163W00000X
NY20110545163WD0400X
NJ20110545163WD0400X
NY355184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty