MEDICARE: GINA MARIE 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	208D00000X	General Practice Physician	48510	CO

General Provider Information

NPI Number	:	1548473630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE NELSON MD

Provider Business Mailing Address
First Line	:	215 S WADSWORTH BLVD STE 420
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1566
Country	:	US
Telephone Number	:	720-722-3635
Fax Number	:	303-986-9839

Provider Business Practice Location Address
First Line	:	215 S WADSWORTH BLVD STE 420
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-1566
Country	:	US
Telephone Number	:	720-722-3635
Fax Number	:	303-986-9839

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

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	03/11/2020

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