Provider Demographics
NPI:1366058695
Name:NELSON, NOURA ZAHRA (PA-C)
Entity type:Individual
Prefix:
First Name:NOURA
Middle Name:ZAHRA
Last Name:NELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NOURA
Other - Middle Name:ZAHRA
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7825 BALLANTYNE COMMONS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3175
Practice Address - Country:US
Practice Address - Phone:701-316-3070
Practice Address - Fax:704-316-3071
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007446363A00000X
NC0010-13808363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant