Provider Demographics
NPI:1598964942
Name:ROURA, NELSON CHRISTIANO II (CPO)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:CHRISTIANO
Last Name:ROURA
Suffix:II
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 SAINT LEO ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3382
Mailing Address - Country:US
Mailing Address - Phone:336-621-9500
Mailing Address - Fax:336-621-0980
Practice Address - Street 1:2800 SAINT LEO ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-3382
Practice Address - Country:US
Practice Address - Phone:336-621-9500
Practice Address - Fax:336-621-0980
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC363151744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management