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NPI Code Detail

MEDICARE: MR. KEITH A NELSON SR.

MEDICARE: MR. KEITH A NELSON SR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171WH0202XHome Modifications Contractor1502165OH

General Provider Information

NPI Number : 1538312285
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEITH A NELSON SR.
Provider Business Mailing Address
First Line : PO BOX 352392
Second Line :
City : TOLEDO
State : OH
Zip : 43635-2392
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2220 IRVINGTON
Second Line :
City : TOLEDO
State : OH
Zip : 43606
Country : US
Telephone Number : 419-367-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2008
Last Update Date : 10/28/2008

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Directions to “ MR. KEITH A NELSON SR. ” Practice Location

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