Healthcare Provider Details

I. General information

NPI: 1992554497
Provider Name (Legal Business Name): CHRISTINA R NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISSY NELSON RN, IBCLC

II. Dates (important events)

Enumeration Date: 05/16/2024
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 BIRCH ST
PEMBROKE MA
02359-3702
US

IV. Provider business mailing address

86 BIRCH ST
PEMBROKE MA
02359-3702
US

V. Phone/Fax

Practice location:
  • Phone: 781-588-2495
  • Fax:
Mailing address:
  • Phone: 781-588-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2258857
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2258857
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-100176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: