Individual provider · NPI-1
Dedra Taree Nelson, Home Health
Home Health Aide · Racine, WI
NPI number1174878128
StatusActive
Last updated in NPPESJul 16, 2012
Details
- NPI
- 1174878128
- Entity type
- Individual (NPI-1)
- Name
- Dedra Taree Nelson
- Credential
- Home Health
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jul 16, 2012
- Last updated
- Jul 16, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 374U00000X | Home Health Aide | – | – | Yes |
Practice location
2808 15th StRacine, WI 53405-5013
Phone 262-721-8567
Mailing address
2808 15th StRacine, WI 53405-5013
Phone 262-721-8567
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