1730651175 NPI number — AARON YOO NELSON

Table of content: AARON YOO NELSON (NPI 1730651175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730651175 NPI number — AARON YOO NELSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
AARON
Provider Middle Name:
YOO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1730651175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 HANOVER ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03766-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-448-0126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 W PLEASANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAREMONT
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03743-3055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-542-2578
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2018

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3077550 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".




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