Provider Demographics
NPI:1689266280
Name:NELSON, DANIEL COLE (RN)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:COLE
Last Name:NELSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 MAIN STREET ER
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-9696
Mailing Address - Country:US
Mailing Address - Phone:716-358-3636
Mailing Address - Fax:716-358-2342
Practice Address - Street 1:356 MAIN STREET ER
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NY
Practice Address - Zip Code:14772-9696
Practice Address - Country:US
Practice Address - Phone:716-358-3636
Practice Address - Fax:716-358-2342
Is Sole Proprietor?:No
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY379690146L00000X
NY752724163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic