Provider Demographics
NPI:1942069190
Name:NELSON, YOLANDA LORRAINE
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LORRAINE
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 1:1930 N CARROLL AVE APT 509
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8831
Mailing Address - Country:US
Mailing Address - Phone:972-834-8768
Mailing Address - Fax:
Practice Address - Street 1:1930 N CARROLL AVE APT 509
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8831
Practice Address - Country:US
Practice Address - Phone:972-834-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50272-0122174400000X, 175T00000X
174400000X
TX50423-0322175T00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No174400000XOther Service ProvidersSpecialist