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General NPI Number Information
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NPI Number | 1679114805
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Entity Type | Individual
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Provider Name | PHYLLIS ADOLPHUS NELSON PMHNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/29/2019
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 3281 COOLIDGE HWY
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City | BERKLEY
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State | MI
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Zip | 48072-1633
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Country | US
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Telephone | 313-915-9138
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Fax | 313-216-2776
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Provider Business Mailing Address
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Address Line | 1941 ORLEANS ST APT 632
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City | DETROIT
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State | MI
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Zip | 48207-2754
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Country | US
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Telephone | 248-907-4970
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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 | 4704184714
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704184714
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License Number State | MI
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