MEDICARE: MR. GEORGE IRA NELSON APRN, CRNA

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	367500000X	Certified Registered Nurse Anesthetist	RN066085	LA
2	367500000X	Certified Registered Nurse Anesthetist	209008541	IL

General Provider Information

NPI Number	:	1760474225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GEORGE IRA NELSON APRN, CRNA

Provider Business Mailing Address
First Line	:	3333 N SEMINARY ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-1251
Country	:	US
Telephone Number	:	309-344-9430
Fax Number	:

Provider Business Practice Location Address
First Line	:	3333 N SEMINARY ST
Second Line	:
City	:	GALESBURG
State	:	IL
Zip	:	61401-1251
Country	:	US
Telephone Number	:	309-344-9430
Fax Number	:

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	02/11/2025

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