Healthcare Provider Details

I. General information

NPI: 1427454990
Provider Name (Legal Business Name): WANDA MARIE NELSON RDH, MS, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2014
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 WONDY WAY
DANBURY CT
06811
US

IV. Provider business mailing address

36 WONDY WAY
DANBURY CT
06811
US

V. Phone/Fax

Practice location:
  • Phone: 203-788-7589
  • Fax:
Mailing address:
  • Phone: 203-788-7589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number018979-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number03028
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberIDA-3159986
License Number State
# 4
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number004619
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: