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General NPI Number Information
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NPI Number | 1124505219
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Entity Type | Individual
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Provider Name | THERESA JOAN NELSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/23/2018
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Last Update Date | 07/23/2018
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Provider Practice Location Address
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Address Line | 805 S MADISON ST
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City | WHITEVILLE
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State | NC
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Zip | 28472-4613
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Country | US
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Telephone | 910-642-2050
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Fax |
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Provider Business Mailing Address
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Address Line | 7490 ANDREW JACKSON HWY SW
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City | CERRO GORDO
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State | NC
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Zip | 28430-9258
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Country | US
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Telephone | 910-654-2050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5010716
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License Number State | NC
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