Individual
RENEE SUSANNE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1301 PUNCHBOWL ST, HONOLULU, HI 96813-2499
(808) 691-7143
(808) 691-7496
Mailing address
PO BOX 1009, SPRING VALLEY, CA 91979-1009
(619) 508-0908
(619) 693-3242
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
G78214
CA
207RP1001X
Pulmonary Disease Physician
Primary
G78214
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G782140
—
CA
01
—
BM836Z
MEDICARE PTAN
—
Enumeration date
09/05/2006
Last updated
04/17/2023
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