Healthcare Provider Details

I. General information

NPI: 1295286052
Provider Name (Legal Business Name): ANTHONY NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E RIDGE RD SUITE 204
MCALLEN TX
78503-1251
US

IV. Provider business mailing address

10851 N STEWART RD
MISSION TX
78573-8323
US

V. Phone/Fax

Practice location:
  • Phone: 956-632-6020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number779877
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP132975
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: