Provider Demographics
NPI:1902931710
Name:NELSON, LYLE (CMA)
Entity type:Individual
Prefix:MR
First Name:LYLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 HUMBOLDT ST
Mailing Address - Street 2:# 402
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2373
Mailing Address - Country:US
Mailing Address - Phone:303-832-1128
Mailing Address - Fax:303-832-1128
Practice Address - Street 1:1733 VINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-1119
Practice Address - Country:US
Practice Address - Phone:303-504-1000
Practice Address - Fax:303-394-9820
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS497707174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist