Provider Demographics
NPI:1871331348
Name:NELSON, SANTANA NICOLE
Entity type:Individual
Prefix:
First Name:SANTANA
Middle Name:NICOLE
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 1:26241 LAKE SHORE BLVD APT 767
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1143
Mailing Address - Country:US
Mailing Address - Phone:216-333-2338
Mailing Address - Fax:
Practice Address - Street 1:26241 LAKE SHORE BLVD APT 767
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1143
Practice Address - Country:US
Practice Address - Phone:216-333-2338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372600000X, 374U00000X
OH601357320524376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide