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General NPI Number Information
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NPI Number | 1265535629
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Entity Type | Individual
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Provider Name | ROBERT HUGO NELSON PAC
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 123 MEDICAL CENTER DR MID COAST HOSPITAL
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City | BRUNSWICK
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State | ME
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Zip | 04011
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Country | US
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Telephone | 207-373-6086
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Fax | 207-373-6080
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Provider Business Mailing Address
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Address Line | 23 ARROWSIC RD
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City | ARROWSIC
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State | ME
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Zip | 04530
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Country | US
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Telephone | 207-448-9623
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA595
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA595
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA595
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License Number State | ME
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