Individual
MR. NELVIN GLENN BERGONIA ISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
310 E PULASKI HWY, ELKTON, MD 21921-6435
(443) 485-6213
(443) 485-6226
Mailing address
104 PLUMTREE RD, BEL AIR, MD 21015-6095
(410) 515-4300
(410) 601-1052
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R176504
MD
363L00000X
Nurse Practitioner
LG-0012948
DE
363L00000X
Nurse Practitioner
R176504
MD
363LF0000X
Family Nurse Practitioner
LG-0012948
DE
363LF0000X
Family Nurse Practitioner
Primary
R176504
MD
Other
Enumeration date
06/28/2019
Last updated
10/29/2024
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