Provider Demographics
NPI:1891575569
Name:NELSON, CHRISTIAN O
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:O
Last Name:NELSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16714 SARMORR ST
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-3212
Mailing Address - Country:US
Mailing Address - Phone:586-563-0947
Mailing Address - Fax:
Practice Address - Street 1:16714 SARMORR ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3212
Practice Address - Country:US
Practice Address - Phone:586-563-0947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide