Provider Demographics
NPI:1619293776
Name:NELSON, YOLANDA YVONNE
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:YVONNE
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 1:1918 W ROBBINS ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1235
Mailing Address - Country:US
Mailing Address - Phone:903-262-8577
Mailing Address - Fax:
Practice Address - Street 1:1918 W ROBBINS ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1235
Practice Address - Country:US
Practice Address - Phone:903-262-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities