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General NPI Number Information
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NPI Number | 1790039998
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Entity Type | Individual
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Provider Name | DEANN LYNN NELSON RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 1901 RED ROCK DR
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City | GALLUP
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State | NM
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Zip | 87301-5683
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Country | US
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Telephone | 505-863-7141
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Fax |
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Provider Business Mailing Address
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Address Line | 10849 AREZZO DR NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-5281
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Country | US
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Telephone | 505-870-1267
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R62373
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CNP-03460
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License Number State | NM
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