Healthcare Provider Details

I. General information

NPI: 1225224819
Provider Name (Legal Business Name): VIERA NELSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4207 E COTTON CENTER BLVD. BUILDING 10
PHOENIX AZ
85040
US

IV. Provider business mailing address

PO BOX 840294
DALLAS TX
75284-0294
US

V. Phone/Fax

Practice location:
  • Phone: 888-276-2223
  • Fax: 972-767-0225
Mailing address:
  • Phone: 888-344-1160
  • Fax: 972-331-3148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA62316
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number44889
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: