Provider Demographics
NPI:1164053385
Name:NELSON, ELAINE MARIE (COSMETIC THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:COSMETIC THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5822 WOODHILL ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-5167
Mailing Address - Country:US
Mailing Address - Phone:440-477-4074
Mailing Address - Fax:
Practice Address - Street 1:COSMETIC LASER INC
Practice Address - Street 2:8353 MENTOR AVE. UNIT 7
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-477-4074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH32.012312247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other