Provider Demographics
NPI:1932674918
Name:NELSON, RONNIE CHARLES
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:CHARLES
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 1:19015 ASHTON AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-2962
Mailing Address - Country:US
Mailing Address - Phone:313-532-3072
Mailing Address - Fax:
Practice Address - Street 1:19015 ASHTON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-2962
Practice Address - Country:US
Practice Address - Phone:313-532-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health