MEDICARE: DR. MARIE S NELSON DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	5901001597	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083612436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE S NELSON DPM

Provider Business Mailing Address
First Line	:	790 VETERANS WAY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507-1000
Country	:	US
Telephone Number	:	850-912-2277
Fax Number	:	850-912-2497

Provider Business Practice Location Address
First Line	:	790 VETERANS WAY
Second Line	:
City	:	PENSACOLA
State	:	FL
Zip	:	32507
Country	:	US
Telephone Number	:	850-912-2277
Fax Number	:	850-912-2497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	06/18/2018

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