Healthcare Provider Details

I. General information

NPI: 1194079228
Provider Name (Legal Business Name): VALERIE C NELSON MS CM LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S OB/GYN - BUILDING 1, BASEMENT SOUTH
BRONX NY
10461-1138
US

IV. Provider business mailing address

5 WHANG HOLLOW RD
CARMEL NY
10512
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-6300
  • Fax:
Mailing address:
  • Phone: 914-924-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberF001494-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: