Provider Demographics
NPI:1043091226
Name:NELSON, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 NORTH MOAPA VALLEY BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:MOAPA VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89021
Mailing Address - Country:US
Mailing Address - Phone:702-357-8317
Mailing Address - Fax:702-357-8317
Practice Address - Street 1:4920 NORTH MOAPA VALLEY BOULEVARD
Practice Address - Street 2:
Practice Address - City:MOAPA VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89021
Practice Address - Country:US
Practice Address - Phone:702-357-8317
Practice Address - Fax:702-357-8317
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant