Healthcare Provider Details

I. General information

NPI: 1801849005
Provider Name (Legal Business Name): DOLORES A NELSON CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 04/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36001 EUCLID AVE SUITE C-17
WILLOUGHBY OH
44094-4643
US

IV. Provider business mailing address

36001 EUCLID AVE SUITE C-17
WILLOUGHBY OH
44094-4643
US

V. Phone/Fax

Practice location:
  • Phone: 440-946-4662
  • Fax: 440-946-4084
Mailing address:
  • Phone: 440-946-4662
  • Fax: 440-946-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP03177
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: