Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3012261 | KY |
NPI | 1003305525 |
---|---|
Provider Name | Cherry E Nelson |
First Address | Chicago, IL 60677-6351 |
Second Address | Louisville, KY 40217-1385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2018 |
Last Update Date | 26/10/2020 |