Provider Demographics
NPI:1699772400
Name:NELSON, LOLA MAY (LIC MIDWIFE)
Entity type:Individual
Prefix:
First Name:LOLA
Middle Name:MAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:LIC MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 SE JEFFERSON STREET
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-287-3608
Mailing Address - Fax:772-287-3608
Practice Address - Street 1:3333 SE JEFFERSON STREET
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:772-287-3608
Practice Address - Fax:772-287-3608
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAC1320848176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife