MEDICARE: COREY ANN NELSON

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	343900000X	Non-emergency Medical Transport (VAN)	7493754	NM

General Provider Information

NPI Number	:	1306617014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY ANN NELSON

Provider Business Mailing Address
First Line	:	583 OSUNA RD NE STE F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1030
Country	:	US
Telephone Number	:	505-369-8291
Fax Number	:

Provider Business Practice Location Address
First Line	:	583 OSUNA RD NE STE F
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1030
Country	:	US
Telephone Number	:	505-369-8291
Fax Number	:

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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