MEDICARE: MS. KATRINA MARIE NELSON L.P.N.

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	164W00000X	Licensed Practical Nurse	313707	NY

General Provider Information

NPI Number	:	1316381254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATRINA MARIE NELSON L.P.N.

Provider Business Mailing Address
First Line	:	5508 CHELSEA CV N
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7106
Country	:	US
Telephone Number	:	845-592-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	5508 CHELSEA CV N
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-7106
Country	:	US
Telephone Number	:	845-592-8382
Fax Number	:

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

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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