Individual
SANDRA K NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
424 YELLOWSTONE AVE., STE 220, CODY, WY 82414
(307) 578-2500
(307) 578-2492
Mailing address
707 SHERIDAN AVE, CODY, WY 82414
(307) 578-2500
(307) 578-2492
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
50611
WI
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
9486A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029939
BLUE CROSS BLUE SHIELD
—
05
—
34916000
—
WI
01
—
35564
MONTANA MEDICAID
MT
01
—
39859
BLUE CROSS
ID
05
—
IP805843700
—
ID
Enumeration date
10/03/2006
Last updated
10/05/2020
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