Provider Demographics
NPI:1043193485
Name:NELSON, CORINNA DAWN CHRISTOPHER (R255152)
Entity type:Individual
Prefix:
First Name:CORINNA
Middle Name:DAWN CHRISTOPHER
Last Name:NELSON
Suffix:
Gender:F
Credentials:R255152
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19405 EMERALD SQ STE 201
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-3637
Mailing Address - Country:US
Mailing Address - Phone:814-285-7454
Mailing Address - Fax:814-285-7454
Practice Address - Street 1:19405 EMERALD SQ STE 201
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-3637
Practice Address - Country:US
Practice Address - Phone:240-347-2800
Practice Address - Fax:814-285-7454
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR255152163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse