Provider Demographics
NPI:1073121679
Name:WEBB, NELSON WYCHE III (PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:WYCHE
Last Name:WEBB
Suffix:III
Gender:M
Credentials:PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 BIG OAK TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-4152
Mailing Address - Country:US
Mailing Address - Phone:248-425-1918
Mailing Address - Fax:
Practice Address - Street 1:4901 BIG OAK TRAIL DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-4152
Practice Address - Country:US
Practice Address - Phone:248-425-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIA038916146L00000X
146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic