=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336255025
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN N. NELSON DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2006
-----------------------------------------------------
Last Update Date | 03/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1606 S DUFF AVE STE 500
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-8156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-444-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1606 S DUFF AVE STE 500
-----------------------------------------------------
City | AMES
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50010-8156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 515-444-2390
-----------------------------------------------------
Fax | 515-898-8586
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 00796
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------