MEDICARE: NICHOLAS ALAN NELSON RN

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	163WC1500X	Community Health Registered Nurse	95238896	CA
2	163WC1600X	Continuing Education/Staff Development Registered Nurse	95238896	CA
3	163WE0003X	Emergency Registered Nurse	95238896	CA
4	163WA2000X	Administrator Registered Nurse	95238896	CA

General Provider Information

NPI Number	:	1093422107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ALAN NELSON RN

Provider Business Mailing Address
First Line	:	5239 CLAREMONT AVE UNIT 28
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1795
Country	:	US
Telephone Number	:	773-458-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	5239 CLAREMONT AVE UNIT 28
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94618-1795
Country	:	US
Telephone Number	:	773-458-8022
Fax Number	:

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

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	11/05/2022

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