Healthcare Provider Details

I. General information

NPI: 1477182913
Provider Name (Legal Business Name): ELIZABETH PAGE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 CAMINO FRANCISCA
SANTA FE NM
87506-6000
US

IV. Provider business mailing address

746 CAMINO FRANCISCA
SANTA FE NM
87506-6000
US

V. Phone/Fax

Practice location:
  • Phone: 443-739-7706
  • Fax:
Mailing address:
  • Phone: 443-739-7706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2026-0585
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: