Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 6034 | OK |
NPI | 1023493566 |
---|---|
Provider Name | Chase K Nelson |
First Address | Rupert, ID 83350-1535 |
Second Address | Rupert, ID 83350-1535 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 19/11/2020 |