Provider Demographics
NPI:1912573387
Name:CASTELLANOS, NELENE (LVN)
Entity Type:Individual
Prefix:
First Name:NELENE
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 MIDDLETON RD # B
Mailing Address - Street 2:
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-6324
Mailing Address - Country:US
Mailing Address - Phone:912-344-9210
Mailing Address - Fax:
Practice Address - Street 1:10222 MIDDLETON RD # B
Practice Address - Street 2:
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-6324
Practice Address - Country:US
Practice Address - Phone:912-344-9210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN274493164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse