Provider Demographics
NPI:1982989844
Name:NELSON, PASHA VENETTE (STNA)
Entity Type:Individual
Prefix:
First Name:PASHA
Middle Name:VENETTE
Last Name:NELSON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 E WOODROW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-5432
Mailing Address - Country:US
Mailing Address - Phone:614-376-8484
Mailing Address - Fax:
Practice Address - Street 1:1136 E WOODROW AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-5432
Practice Address - Country:US
Practice Address - Phone:614-376-8484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400678351007376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide