Provider Demographics
NPI:1902895428
Name:NELSON, LORI A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:A
Last Name:NELSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:9750 LEVIN RD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8399
Mailing Address - Country:US
Mailing Address - Phone:360-307-7202
Mailing Address - Fax:360-698-6600
Practice Address - Street 1:9750 LEVIN RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8399
Practice Address - Country:US
Practice Address - Phone:360-307-7202
Practice Address - Fax:360-698-6600
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003851363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA11034883OtherCAQH
NEL1-0430-4371OtherNATIONAL BOARD CERTIFICATION - NCC
WAAP30003851OtherWA LICENSE ARNP
WAMN2674718OtherDEA
WA11034883OtherCAQH
WAMN2674718OtherDEA