Provider Demographics
NPI:1669623906
Name:NELSON, TANISHA MEKLA (RN)
Entity type:Individual
Prefix:MRS
First Name:TANISHA
Middle Name:MEKLA
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TANISHA
Other - Middle Name:MEKLA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7339 LORETTO AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3847
Mailing Address - Country:US
Mailing Address - Phone:215-778-9972
Mailing Address - Fax:215-364-0851
Practice Address - Street 1:7339 LORETTO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3847
Practice Address - Country:US
Practice Address - Phone:215-778-9972
Practice Address - Fax:215-364-0851
Is Sole Proprietor?:No
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA523427L163WM0705X
PA246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory