Provider Demographics
NPI:1356012603
Name:NELSON, CONSQUELLA REENA
Entity Type:Individual
Prefix:
First Name:CONSQUELLA
Middle Name:REENA
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 1:1307 COLUMBIA RD NW APT 204
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4935
Mailing Address - Country:US
Mailing Address - Phone:202-594-0906
Mailing Address - Fax:
Practice Address - Street 1:4209 E CAPITOL ST SE APT 4
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-4473
Practice Address - Country:US
Practice Address - Phone:202-271-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide