Provider Demographics
NPI:1285086603
Name:AVALLON DUKE, NELSA S (MSN, RN, CPNP)
Entity type:Individual
Prefix:
First Name:NELSA
Middle Name:S
Last Name:AVALLON DUKE
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 E MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-1801
Mailing Address - Country:US
Mailing Address - Phone:413-846-5120
Mailing Address - Fax:
Practice Address - Street 1:51 E MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1801
Practice Address - Country:US
Practice Address - Phone:413-846-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2321084363LP0200X
NY382739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics