MEDICARE: E. HARBIN NELSON M.D. PLLC

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	174400000X	Specialist	25967	OK

General Provider Information

NPI Number	:	1831480532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	E. HARBIN NELSON M.D. PLLC

Provider Business Mailing Address
First Line	:	322 KAREN AVE
Second Line	:	#2805
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-0412
Country	:	US
Telephone Number	:	800-458-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 KAREN AVE
Second Line	:	#2805
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-0412
Country	:	US
Telephone Number	:	800-458-7172
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ELIZABETH HARBIN NELSON
Credential	:	M.D.
Telephone Number	:	800-458-7172

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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