Provider Demographics
NPI:1487342168
Name:NELSON, THOMAS A III
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:NELSON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116A BREAKNECK AVE
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2201
Mailing Address - Country:US
Mailing Address - Phone:724-562-8051
Mailing Address - Fax:
Practice Address - Street 1:116A BREAKNECK AVE
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2201
Practice Address - Country:US
Practice Address - Phone:724-562-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA69333601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health