Provider Demographics
NPI:1922679679
Name:NELSON, ELISA JOY
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:JOY
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 1:239 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1108
Mailing Address - Country:US
Mailing Address - Phone:419-388-9832
Mailing Address - Fax:
Practice Address - Street 1:239 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1108
Practice Address - Country:US
Practice Address - Phone:419-388-9832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-04
Last Update Date:2021-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health