Individual
CAROLINE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1718 E KESSLER BLVD, LONGVIEW, WA 98632
(360) 747-5800
Mailing address
1718 E KESSLER BLVD, LONGVIEW, WA 98632-1842
(360) 747-5800
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E1751525
—
363A00000X
Physician Assistant
Primary
PA60898310
WA
363AM0700X
Medical Physician Assistant
LICENSE
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2018
Last updated
06/12/2019
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