Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 5901001597 | MI |
NPI | 1083612436 |
---|---|
Provider Name | Dr. Marie S Nelson |
First Address | Pensacola, FL 32507-1000 |
Second Address | Pensacola, FL 32507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 18/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4480692 | (05) | MI |
U41652 | (02) | MI |