Basic Information
| Provider Information | |||||||||
| NPI: | 1952771867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | ALEXA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 MARTENSE ST | ||||||||
| Address2: | APT C5 | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112264262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176913077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1847 MOTT AVE | ||||||||
| Address2: | |||||||||
| City: | FAR ROCKAWAY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 116914201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183376850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 10/05/2015 | ||||||||
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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 | 163W00000X | 6571301 | NY | Y | Nursing Service Providers | Registered Nurse |
No ID Information.