Provider Demographics
NPI:1144596420
Name:NEL, MARLENA SUE (ATP)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:SUE
Last Name:NEL
Suffix:
Gender:F
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MEADOWFAIR CT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2624
Mailing Address - Country:US
Mailing Address - Phone:832-922-7238
Mailing Address - Fax:
Practice Address - Street 1:4 MEADOWFAIR CT
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2624
Practice Address - Country:US
Practice Address - Phone:832-922-7238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5509247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
5509OtherRESNA ATP