Provider Demographics
NPI:1215911003
Name:NEILSON, LORRAINE KAY (DO)
Entity type:Individual
Prefix:MRS
First Name:LORRAINE
Middle Name:KAY
Last Name:NEILSON
Suffix:
Gender:F
Credentials:DO
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 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-6282
Mailing Address - Fax:828-687-6285
Practice Address - Street 1:1881 PISGAH DR
Practice Address - Street 2:BUILDING A
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3760
Practice Address - Country:US
Practice Address - Phone:828-697-4336
Practice Address - Fax:828-694-6756
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701081207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082MOtherBCBS NC
NC891082MMedicaid
NCP00466507OtherMEDICARE RAILROAD
NCP00466507OtherMEDICARE RAILROAD
NC891082MMedicaid