Provider Demographics
NPI:1447811534
Name:ISON, NELVIN GLENN BERGONIA (CRNP)
Entity type:Individual
Prefix:MR
First Name:NELVIN GLENN
Middle Name:BERGONIA
Last Name:ISON
Suffix:
Gender:M
Credentials:CRNP
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Mailing Address - Street 1:104 PLUMTREE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-6095
Mailing Address - Country:US
Mailing Address - Phone:410-515-4300
Mailing Address - Fax:410-601-1052
Practice Address - Street 1:310 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6435
Practice Address - Country:US
Practice Address - Phone:443-485-6213
Practice Address - Fax:443-485-6226
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR176504163W00000X, 363L00000X, 363LF0000X
DELG-0012948363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner