Provider Demographics
NPI:1225585631
Name:NELSON, DANYELLE
Entity Type:Individual
Prefix:
First Name:DANYELLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111-119 CHURCH ST
Mailing Address - Street 2:SUITE 104-105
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2441
Mailing Address - Country:US
Mailing Address - Phone:314-736-1388
Mailing Address - Fax:
Practice Address - Street 1:111-119 CHURCH ST
Practice Address - Street 2:SUITE 104-105
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2441
Practice Address - Country:US
Practice Address - Phone:314-736-1388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide