MEDICARE: DR. SARAH DANIELLE NELSON M.D.

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	207V00000X	Obstetrics & Gynecology Physician	25MA09088600	NJ
2	207V00000X	Obstetrics & Gynecology Physician	P5853	TX

General Provider Information

NPI Number	:	1730314634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH DANIELLE NELSON M.D.

Provider Business Mailing Address
First Line	:	1601 LIBERTY ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3252
Country	:	US
Telephone Number	:	281-342-6962
Fax Number	:	281-342-6963

Provider Business Practice Location Address
First Line	:	1601 LIBERTY ST
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-3252
Country	:	US
Telephone Number	:	281-342-6962
Fax Number	:	281-342-6963

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	08/08/2013

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