Healthcare Provider Details

I. General information

NPI: 1750912754
Provider Name (Legal Business Name): MARIE SONIE NELSON MD, PA, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 GUILD RD
BROCKTON MA
02302-3224
US

IV. Provider business mailing address

31 GUILD RD
BROCKTON MA
02302-2942
US

V. Phone/Fax

Practice location:
  • Phone: 774-296-8859
  • Fax:
Mailing address:
  • Phone: 774-296-8859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2322079
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA622
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: