Individual
PAMELA JAYNE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8253
Mailing address
189 ALMA ST, SPARTA, MI 49345-1146
(231) 286-0030
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704153516
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704153516
REGISTERED NURSING
MI
Enumeration date
07/23/2018
Last updated
07/23/2018
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