| Doctor Name: | MS. LISA ANN NELSON |
| NPI Number: | 1174705982 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-PSYCHIATRY |
| License Number: | F401077-1 |
| Business Practice Address: | 3771 Nesconset Highway Suite 212 South Setauket, NY - 11720 |
| Business Phone Number: | 6316895390 |
| Business Fax Number: | 6316895395 |
| Mailing Address: | 3771 Nesconset Hwy 212, SOUTH SETAUKET |
| State: | NY |
| Postal Code: | 117201154 |
| Phone Number: | 6316895390 |
| Fax Number: | 6316895395 |
| NPI Enumeration Date: | 12/04/2007 |
| NPI Last Update Date: | 03/16/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | F401077-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |