MEDICARE: ANNA L NELSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	35-122352	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114219516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA L NELSON MD

Provider Business Mailing Address
First Line	:	7045 LIGHTHOUSE WAY
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-7000
Country	:	US
Telephone Number	:	419-873-6836
Fax Number	:	419-873-6837

Provider Business Practice Location Address
First Line	:	7045 LIGHTHOUSE WAY
Second Line	:
City	:	PERRYSBURG
State	:	OH
Zip	:	43551-7000
Country	:	US
Telephone Number	:	419-873-6836
Fax Number	:	419-873-6837

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	03/31/2020

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