Provider Demographics
NPI:1710343413
Name:NELSON, ANDREA JO (LPN)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:JO
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 BERGHOLZ RD NE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44651-9039
Mailing Address - Country:US
Mailing Address - Phone:330-316-1281
Mailing Address - Fax:
Practice Address - Street 1:256 BERGHOLZ RD NE
Practice Address - Street 2:
Practice Address - City:MECHANICSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44651-9039
Practice Address - Country:US
Practice Address - Phone:330-316-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 089937164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse