Individual
MS. IRENE ANN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1490 GREGORY LANE, JACKSON, WY 83002
(307) 732-1694
(307) 732-1693
Mailing address
PO B 11659, JACKSON, WY 83002
(307) 732-1694
(307) 732-1693
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
158
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1024755
NCCPA
—
Enumeration date
12/10/2012
Last updated
12/10/2012
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