Individual
CHRISTOPHER L NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
360 BROADWAY, BANGOR, ME 04401-3979
(207) 907-1770
(207) 907-3675
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8941
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA691
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA691
STATE LICENSE
ME
Enumeration date
06/14/2006
Last updated
01/02/2025
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