MEDICARE: MARQUIS A NELSON

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1760968556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUIS A NELSON

Provider Business Mailing Address
First Line	:	5892 LOSEE RD STE 132-172
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5892 LOSEE RD STE 132-172
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-6599
Country	:	US
Telephone Number	:	702-689-6745
Fax Number	:

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

Provider Enumeration Date	:	07/14/2018
Last Update Date	:	07/14/2018

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Directions to “ MARQUIS A NELSON ” Practice Location

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