Provider Demographics
NPI:1578243648
Name:NELSON, LORRAINE J (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:J
Last Name:NELSON
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 VAIL DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-6789
Mailing Address - Country:US
Mailing Address - Phone:214-228-7921
Mailing Address - Fax:
Practice Address - Street 1:2022 VAIL DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-6789
Practice Address - Country:US
Practice Address - Phone:214-228-7921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach