Healthcare Provider Details

I. General information

NPI: 1528357613
Provider Name (Legal Business Name): MARIE VERONICA NELSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE VERONICA VERVAEKE MD

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3571 W 13 MILE RD
ROYAL OAK MI
48073-6710
US

IV. Provider business mailing address

26901 BEAUMONT BLVD STE 3D
SOUTHFIELD MI
48033-3849
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-0360
  • Fax:
Mailing address:
  • Phone: 947-522-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD042413
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number4301510021
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: