Provider Demographics
NPI:1033140884
Name:NELSEN, MARIE JOYNER
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:JOYNER
Last Name:NELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 TULSA CIR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2401
Mailing Address - Country:US
Mailing Address - Phone:805-901-3819
Mailing Address - Fax:
Practice Address - Street 1:1901 SOLAR DR STE 265
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2692
Practice Address - Country:US
Practice Address - Phone:805-746-4667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16053363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology