Provider Demographics
NPI:1124169362
Name:NELSON, LAURA ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775383
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5383
Mailing Address - Country:US
Mailing Address - Phone:812-376-5315
Mailing Address - Fax:
Practice Address - Street 1:2118 25TH ST STE D
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3240
Practice Address - Country:US
Practice Address - Phone:812-372-8281
Practice Address - Fax:812-372-4525
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001261363LF0000X
IN71001261A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200523270Medicaid
INM400030679Medicare PIN
INQ45890Medicare UPIN
IN200523270Medicaid