Healthcare Provider Details

I. General information

NPI: 1659105351
Provider Name (Legal Business Name): ELIZABETH NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 LOS ARBOLES AVE NE STE 100
ALBUQUERQUE NM
87107-1962
US

IV. Provider business mailing address

8 APPLEWOOD LN NW
LOS RANCHOS NM
87107-6404
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-7771
  • Fax:
Mailing address:
  • Phone: 505-250-7107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: