Provider Demographics
NPI:1184787681
Name:NELSON, MARCIA DEE (RN, CNM)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:DEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:DEE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CNM
Mailing Address - Street 1:623 RUSSELL BLVD
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1247
Mailing Address - Country:US
Mailing Address - Phone:936-305-5277
Mailing Address - Fax:866-859-9363
Practice Address - Street 1:623 RUSSELL BLVD
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1247
Practice Address - Country:US
Practice Address - Phone:936-305-5277
Practice Address - Fax:866-859-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251633367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133241308Medicaid
TX133241308Medicaid
TXR58670Medicare UPIN