Provider Demographics
NPI:1437665437
Name:NELSON, VAMEKA NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:VAMEKA
Middle Name:NICOLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:639 LONGFELLOW ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-3015
Mailing Address - Country:US
Mailing Address - Phone:202-257-2657
Mailing Address - Fax:
Practice Address - Street 1:639 LONGFELLOW ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-3015
Practice Address - Country:US
Practice Address - Phone:202-257-2657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC$$$$$$$$$OtherAETNA
MD$$$$$$$$$Medicaid
DC$$$$$$$$$Medicaid