Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | D10998 | MN |
Y | 1223P0106X | Oral and Maxillofacial Pathology | DDS105643 | CA |
NPI | 1275503625 |
---|---|
Provider Name | Dr. Brenda Lee Nelson |
First Address | Germantown, MD 20874 |
Second Address | San Diego, CA 92121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 03/06/2021 |