Provider Demographics
NPI:1720601198
Name:NELSON, ROSE
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
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:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53952
Mailing Address - Country:US
Mailing Address - Phone:608-445-4771
Mailing Address - Fax:
Practice Address - Street 1:3007 2ND AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:WI
Practice Address - Zip Code:53952
Practice Address - Country:US
Practice Address - Phone:608-345-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider