Healthcare Provider Details

I. General information

NPI: 1447686472
Provider Name (Legal Business Name): AMY YVONNE NELSON N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CARRILLO DR STE 105
LOS ANGELES CA
90048-5400
US

IV. Provider business mailing address

17604 PAULINE CT APT 103
SANTA CLARITA CA
91387-6513
US

V. Phone/Fax

Practice location:
  • Phone: 323-470-0511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND-590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: