MEDICARE: NAKIBA 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	163WC0400X	Case Management Registered Nurse	RN308861	GA
2	163W00000X	Registered Nurse	RN2306380	MA
3	163W00000X	Registered Nurse	RN236380	MA

General Provider Information

NPI Number	:	1962902569
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKIBA NELSON

Provider Business Mailing Address
First Line	:	4905 PROMENADE DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8718
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4905 PROMENADE DR SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8718
Country	:	US
Telephone Number	:	781-913-1630
Fax Number	:

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2026

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