1770814253 NPI number — MR. CHRISTOPHER G NELSON MT(ASCP)

Table of content: MR. CHRISTOPHER G NELSON MT(ASCP) (NPI 1770814253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770814253 NPI number — MR. CHRISTOPHER G NELSON MT(ASCP)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
CHRISTOPHER
Provider Middle Name:
G
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MT(ASCP)
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770814253
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2805 WIMBLEDON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28056-8873
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-674-8995
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 BLACK COAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. WASHAKIE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-332-7692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 246QM0706X , with the licence number:  ASCP 194603 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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