Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 71005840A | IN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71005840A | IN |
NPI | 1083096465 |
---|---|
Provider Name | Courtney Nelson |
First Address | Greenwood, IN 46143-1072 |
Second Address | Greenwood, IN 46143-1072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2015 |
Last Update Date | 20/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201331220 | (05) | IN |