Provider Demographics
NPI:1992093280
Name:NELSON, PAUL D (AUD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:NELSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-0017
Mailing Address - Country:US
Mailing Address - Phone:712-262-7774
Mailing Address - Fax:712-262-6758
Practice Address - Street 1:119 E 5TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5012
Practice Address - Country:US
Practice Address - Phone:712-262-7774
Practice Address - Fax:712-262-6758
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001023237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0125815Medicaid