Provider Demographics
NPI:1124502356
Name:NELSON, HANNAH MARIE (AUD)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:MARIE
Other - Last Name:DOROTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 MOYE BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-4300
Practice Address - Country:US
Practice Address - Phone:252-744-6104
Practice Address - Fax:252-744-6148
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13032231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ64037AOtherMEDICARE
NC202MTOtherBCBS OF NC
NC1124502356Medicaid
NC13032OtherAUDIOLOGY