Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 19790 | IA |
NPI | 1235182676 |
---|---|
Provider Name | Nelson H Chesney |
First Address | Dubuque, IA 52001-7303 |
Second Address | Dubuque, IA 52001-7303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 26/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A01705 | (02) | IA |