Individual
DR. AVERLY H NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
850 MAPLE STREET, EASTERN STATE HOSPITAL, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-4705
Mailing address
PO BOX 800, EASTERN STATE HOSPITAL, MEDICAL LAKE, WA 99022-0800
(509) 565-4000
(509) 565-4705
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD00012481
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1059013
—
WA
Enumeration date
11/16/2005
Last updated
11/02/2016
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