Healthcare Provider Details

I. General information

NPI: 1407178775
Provider Name (Legal Business Name): MARY BARON NELSON RN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MS #81
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

5272 LA CANADA BLVD
LA CANADA CA
91011-1722
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-3033
  • Fax:
Mailing address:
  • Phone: 818-952-0416
  • Fax: 323-361-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number363LP0200X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: