Basic Information
| Provider Information | |||||||||
| NPI: | 1316945678 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | LOIS | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3454 OAK ALLEY CT | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195361322 | ||||||||
| FaxNumber: | 4195360302 | ||||||||
| Practice Location | |||||||||
| Address1: | 3454 OAK ALLEY CT STE 202 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436061370 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195361322 | ||||||||
| FaxNumber: | 4192517715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 35045307 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 0435130 | 05 | OH | MEDICAID |