Individual
LARRY RALPH NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
809 S 15TH ST, MOUNT VERNON, WA 98274-4564
(360) 428-6434
(360) 428-6485
Mailing address
1400 E KINCAID ST, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD00013912
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8167603
—
WA
Enumeration date
04/26/2006
Last updated
07/08/2007
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