Healthcare Provider Details

I. General information

NPI: 1013923952
Provider Name (Legal Business Name): DAVID WAYNE NELSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 GREENFIELD AVE STE D
HANFORD CA
93230-3500
US

IV. Provider business mailing address

440 GREENFIELD AVE STE D
HANFORD CA
93230-3568
US

V. Phone/Fax

Practice location:
  • Phone: 559-582-1045
  • Fax: 559-582-2174
Mailing address:
  • Phone: 559-582-1045
  • Fax: 559-582-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG28470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: