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General NPI Number Information
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NPI Number | 1346356219
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Entity Type | Individual
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Provider Name | JAMES NELSON DPM
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Gender | Male
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 4845 DIVISION AVE S
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City | WYOMING
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State | MI
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Zip | 49548-4498
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Country | US
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Telephone | 616-531-3059
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Fax |
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Provider Business Mailing Address
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Address Line | 1773 WOODSIDE TRL NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-2580
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Country | US
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Telephone | 616-453-1835
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Fax | 616-453-1725
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 5901001738
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License Number State | MI
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