Healthcare Provider Details

I. General information

NPI: 1790653947
Provider Name (Legal Business Name): NANCY NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FALLKILL AVE FL 2
POUGHKEEPSIE NY
12601-2103
US

IV. Provider business mailing address

11 FALLKILL AVE FL 2
POUGHKEEPSIE NY
12601-2103
US

V. Phone/Fax

Practice location:
  • Phone: 347-499-6998
  • Fax:
Mailing address:
  • Phone: 347-499-6998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number870782-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: