Provider Demographics
NPI:1942692660
Name:NELSON, DANESHIA MARIE (LVN)
Entity Type:Individual
Prefix:
First Name:DANESHIA
Middle Name:MARIE
Last Name:NELSON
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 1:3017 S SYCAMORE AVE
Mailing Address - Street 2:APARTMENT 5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-3843
Mailing Address - Country:US
Mailing Address - Phone:323-899-2115
Mailing Address - Fax:
Practice Address - Street 1:3017 S SYCAMORE AVE
Practice Address - Street 2:APARTMENT 5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-3843
Practice Address - Country:US
Practice Address - Phone:323-899-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270074164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse