Healthcare Provider Details

I. General information

NPI: 1427270891
Provider Name (Legal Business Name): KAROL D NELSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3713 LINKWOOD LN
CLOVIS NM
88101
US

IV. Provider business mailing address

3713 LINKWOOD LN
CLOVIS NM
88101
US

V. Phone/Fax

Practice location:
  • Phone: 575-769-3516
  • Fax: 575-769-3516
Mailing address:
  • Phone: 575-769-3516
  • Fax: 575-769-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number60044
License Number StateNM

VIII. Authorized Official

Name: MS. KAROL DAY NELSON
Title or Position: OWNER
Credential: NONE
Phone: 575-769-3516