Healthcare Provider Details

I. General information

NPI: 1043881592
Provider Name (Legal Business Name): ALENA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MELLWOOD AVE # 266
LOUISVILLE KY
40206-1033
US

IV. Provider business mailing address

3639 NICHOLS MEADOW CIR
LOUISVILLE KY
40215-1498
US

V. Phone/Fax

Practice location:
  • Phone: 502-645-6139
  • Fax:
Mailing address:
  • Phone: 502-645-6139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: