Provider Demographics
NPI:1316083652
Name:NELSON, LINNEA J (DO)
Entity type:Individual
Prefix:
First Name:LINNEA
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5701 CASTLE HILL DR APT 957
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5608
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6925 S HARDING ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217
Practice Address - Country:US
Practice Address - Phone:317-497-6140
Practice Address - Fax:317-497-6147
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-07-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN02003127A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01291600OtherRAILROAD MEDICARE
D15921Medicare UPIN