Provider Demographics
NPI:1841621307
Name:NELSON, ELVIRA THERESA (CERT HAIR LOSS SPEC)
Entity type:Individual
Prefix:
First Name:ELVIRA
Middle Name:THERESA
Last Name:NELSON
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 CAMP GROUND RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9442
Mailing Address - Country:US
Mailing Address - Phone:803-210-7669
Mailing Address - Fax:803-333-9831
Practice Address - Street 1:421 BUSH RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7332
Practice Address - Country:US
Practice Address - Phone:803-731-1020
Practice Address - Fax:803-333-9831
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104011744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management