Provider Demographics
NPI:1689340325
Name:NELSON, AMBERIA SHEA
Entity Type:Individual
Prefix:
First Name:AMBERIA
Middle Name:SHEA
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 1:203 W AVIS AVE
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-1103
Mailing Address - Country:US
Mailing Address - Phone:304-688-3009
Mailing Address - Fax:
Practice Address - Street 1:203 W AVIS AVE
Practice Address - Street 2:
Practice Address - City:MAN
Practice Address - State:WV
Practice Address - Zip Code:25635-1103
Practice Address - Country:US
Practice Address - Phone:304-688-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant