Individual
LISA JOAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
789 PRE EMPTION RD, GENEVA, NY 14456-2069
(315) 781-2000
Mailing address
601B W WASHINGTON ST, GENEVA, NY 14456-2119
(315) 787-8151
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
029049
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/11/2022
Last updated
05/13/2026
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