Provider Demographics
NPI:1447932462
Name:NELSEN, WENDY SUE
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUE
Last Name:NELSEN
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 1:12003 PINE CONE CIR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-8722
Mailing Address - Country:US
Mailing Address - Phone:530-263-2971
Mailing Address - Fax:
Practice Address - Street 1:13596 GOLD COUNTRY DR
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9013
Practice Address - Country:US
Practice Address - Phone:530-263-2971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide