Healthcare Provider Details

I. General information

NPI: 1134275365
Provider Name (Legal Business Name): PETER N. NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N. LIDERGERWOOD
SPOKANE WA
99208
US

IV. Provider business mailing address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

V. Phone/Fax

Practice location:
  • Phone: 509-482-0111
  • Fax:
Mailing address:
  • Phone: 509-482-2448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number000020435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: