Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1895 | NC |
NPI | 1215014626 |
---|---|
Provider Name | Dr. Nels Nelsen |
First Address | Goldsboro, NC 27530-3808 |
Second Address | Goldsboro, NC 27530-3808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
085WF | BCBS (01) | NC |
8908661 | (05) | NC |
U42256 | (02) | NC |