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General NPI Number Information
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NPI Number | 1578137337
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Entity Type | Individual
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Provider Name | NICHOLA SAMANTHA NELSON
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Gender | Female
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 6410 ROCKLEDGE DR
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City | BETHESDA
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State | MD
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Zip | 20817-1809
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Country | US
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Telephone | 301-571-0019
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Fax | 240-482-0555
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Provider Business Mailing Address
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Address Line | 5606 FISHERMENS CT
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City | CLINTON
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State | MD
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Zip | 20735-1571
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Country | US
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Telephone | 470-643-9928
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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 | 0024181304
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R208084
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License Number State | MD
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