Provider Demographics
NPI:1073941316
Name:NELSON, STUART
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-4132
Mailing Address - Country:US
Mailing Address - Phone:316-242-6770
Mailing Address - Fax:316-264-1980
Practice Address - Street 1:1600 S TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-4132
Practice Address - Country:US
Practice Address - Phone:316-242-6770
Practice Address - Fax:316-264-1980
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3534171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications