Provider Demographics
NPI:1417726274
Name:NELSON, TAMMI RENE'
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:RENE'
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 1:2814 VIENNA VIEW CT SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-5629
Mailing Address - Country:US
Mailing Address - Phone:330-639-8258
Mailing Address - Fax:
Practice Address - Street 1:2814 VIENNA VIEW CT SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-5629
Practice Address - Country:US
Practice Address - Phone:333-639-8258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No252Y00000XAgenciesEarly Intervention Provider Agency