Provider Demographics
NPI:1366792467
Name:NELSON-HENRY, DONNA M (APN-BC, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:M
Last Name:NELSON-HENRY
Suffix:
Gender:F
Credentials:APN-BC, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GREENTREE CENTER, SOUTH TOWER, SUITE 117
Mailing Address - Street 2:SUITE 117
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053
Mailing Address - Country:US
Mailing Address - Phone:609-604-6758
Mailing Address - Fax:
Practice Address - Street 1:5 GREENTREE CENTER, SOUTH TOWER
Practice Address - Street 2:SUITE 117
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-0805
Practice Address - Country:US
Practice Address - Phone:609-604-6758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-16
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00398700363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily