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General NPI Number Information
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NPI Number | 1609235837
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Entity Type | Individual
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Provider Name | ELDA NELSON
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Gender | Female
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Dates
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Enumeration Date | 02/16/2016
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 1234 NAPIER AVE
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2112
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Country | US
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Telephone | 269-408-4268
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Fax |
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Provider Business Mailing Address
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Address Line | 3891 E SHAWNEE RD
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City | BERRIEN SPRINGS
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State | MI
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Zip | 49103-9765
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Country | US
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Telephone | 269-635-8742
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704214056
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704214056
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License Number State | MI
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