Provider Demographics
NPI:1255721049
Name:NELSON, NOEL LEE (LMT)
Entity type:Individual
Prefix:MS
First Name:NOEL
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 PRAIRIEVIEW LN S
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-2321
Mailing Address - Country:US
Mailing Address - Phone:630-202-5207
Mailing Address - Fax:
Practice Address - Street 1:455 SCOTT DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-3112
Practice Address - Country:US
Practice Address - Phone:630-283-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.001029246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other