Healthcare Provider Details

I. General information

NPI: 1962680108
Provider Name (Legal Business Name): DONALD R NELSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 MESQUITE AVE STE A
LAKE HAVASU CITY AZ
86403-5889
US

IV. Provider business mailing address

1945 MESQUITE AVE STE A
LAKE HAVASU CITY AZ
86403-5889
US

V. Phone/Fax

Practice location:
  • Phone: 928-855-4128
  • Fax: 928-855-7539
Mailing address:
  • Phone: 928-855-4128
  • Fax: 928-855-7539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number05491
License Number StateAZ

VIII. Authorized Official

Name: ARLUENE RUTH LANGEJANS
Title or Position: OFFICE MANAGER
Credential:
Phone: 928-855-4128