MEDICARE: DR. MARY ANNE NELSON MD

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	207Q00000X	Family Medicine Physician	20657	IA

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	:	1225015670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY ANNE NELSON MD

Provider Business Mailing Address
First Line	:	411 10TH ST SE
Second Line	:	STE 1400
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-2467
Country	:	US
Telephone Number	:	319-365-8616
Fax Number	:	319-297-7377

Provider Business Practice Location Address
First Line	:	411 10TH ST SE
Second Line	:	STE 1400
City	:	CEDAR RAPIDS
State	:	IA
Zip	:	52403-2467
Country	:	US
Telephone Number	:	319-365-8616
Fax Number	:	319-297-7377

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	03/08/2026

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