Provider Demographics
NPI:1821493479
Name:NELSON, DEBRA ANN (LPN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
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 1:2271 PINE RD
Mailing Address - Street 2:
Mailing Address - City:RUDOLPH
Mailing Address - State:WI
Mailing Address - Zip Code:54475
Mailing Address - Country:US
Mailing Address - Phone:715-424-4671
Mailing Address - Fax:
Practice Address - Street 1:2271 PINE RD
Practice Address - Street 2:
Practice Address - City:RUDOLPH
Practice Address - State:WI
Practice Address - Zip Code:54475
Practice Address - Country:US
Practice Address - Phone:715-424-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI317774-31320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities