Provider Demographics
NPI:1437746310
Name:NELSON, JOHN WANE III (PLPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WANE
Last Name:NELSON
Suffix:III
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 WRIGHT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2226
Mailing Address - Country:US
Mailing Address - Phone:337-514-5181
Mailing Address - Fax:
Practice Address - Street 1:1325 WRIGHT AVE STE D
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-514-5181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator