Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 292269 | NY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MT210699 | PA |
NPI | 1023564234 |
---|---|
Provider Name | Dr. Susan Elizabeth Nelson |
First Address | Rochester, NY 14642 |
Second Address | Rochester, NY 14625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2016 |
Last Update Date | 17/05/2018 |