Individual
MIRA ROSE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
240 W FRONT ST, PORT ANGELES, WA 98362-2609
(360) 452-7891
Mailing address
550 16TH AVE STE 400, SEATTLE, WA 98122-5636
(206) 360-2484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD61066210
WA
Other
Enumeration date
03/28/2018
Last updated
11/05/2021
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