Provider Demographics
NPI:1760208581
Name:NELSON, MICHAEL
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NELSON
Suffix:
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 1:18 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:WEST MILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45383-1101
Mailing Address - Country:US
Mailing Address - Phone:937-524-1880
Mailing Address - Fax:
Practice Address - Street 1:18 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:WEST MILTON
Practice Address - State:OH
Practice Address - Zip Code:45383-1101
Practice Address - Country:US
Practice Address - Phone:937-524-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle