MEDICARE: MILDRED EMILY NELSON CNM

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	367A00000X	Advanced Practice Midwife	ARNP1154762	FL

General Provider Information

NPI Number	:	1558634329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILDRED EMILY NELSON CNM

Provider Business Mailing Address
First Line	:	3855 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6621
Country	:	US
Telephone Number	:	772-344-2541
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 S US HIGHWAY 1
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-6621
Country	:	US
Telephone Number	:	772-344-2541
Fax Number	:

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

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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