Provider Demographics
NPI:1982879698
Name:NELSON, CINDY (LAC)
Entity Type:Individual
Prefix:MS
First Name:CINDY
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 OLYMPIC HWY N, SUITE 102A
Mailing Address - Street 2:P O BOX 1821
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98548
Mailing Address - Country:US
Mailing Address - Phone:360-462-8087
Mailing Address - Fax:360-462-8087
Practice Address - Street 1:1635 OLYMPIC HWY N STE 102A
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-3065
Practice Address - Country:US
Practice Address - Phone:360-462-8087
Practice Address - Fax:360-462-8087
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00003093171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist