Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MD-45607 | IA |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME 92825 | FL |
N | 208000000X | Pediatrician | 35099088 | OH |
N | 2080P0205X | Pediatric Endocrinologist | 35099088 | OH |
N | 2080P0205X | Pediatric Endocrinologist | ME0092825 | FL |
NPI | 1063494524 |
---|---|
Provider Name | Jeremiah Nelson |
First Address | Mason City, IA 50401-5489 |
Second Address | Mason City, IA 50401-1525 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16865 | BCBS (01) | FL |
2438274001 | CIGNA (01) | FL |
297105 | STAYWELL HEALTHY KIDS (01) | FL |
297631 | AMERIGROUP (01) | FL |
489063073 | HUMANA (01) | FL |
7134730 | AETNA UNITED (01) | FL |
I45404 | (02) | FL |