Provider Demographics
NPI:1427270891
Name:KAROL D NELSON
Entity type:Organization
Organization Name:KAROL D NELSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:DAY
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:575-769-3516
Mailing Address - Street 1:3713 LINKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-769-3516
Mailing Address - Fax:575-769-3516
Practice Address - Street 1:3713 LINKWOOD LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-769-3516
Practice Address - Fax:575-769-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM60044335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66709822Medicaid
NM66709822Medicaid