Provider Demographics
NPI:1083707525
Name:NELSON, JOANNE CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:CLAIRE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:STE 555
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-288-7535
Mailing Address - Fax:503-288-7538
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:STE 555
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-288-7535
Practice Address - Fax:503-288-7538
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD09036208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR237636Medicaid
00WCBDBFMedicare ID - Type Unspecified
OR237636Medicaid