MEDICARE: KAMEO NELSON

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
1	163WR0006X	Registered Nurse First Assistant	60267890	WA

General Provider Information

NPI Number	:	1588287817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMEO NELSON

Provider Business Mailing Address
First Line	:	PO BOX 3229
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-0342
Country	:	US
Telephone Number	:	360-827-5868
Fax Number	:

Provider Business Practice Location Address
First Line	:	3329 UPLAND LN
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-3760
Country	:	US
Telephone Number	:	360-827-2581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2020
Last Update Date	:	05/21/2020

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