Healthcare Provider Details

I. General information

NPI: 1255006219
Provider Name (Legal Business Name): MR. CORINTHIUS NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4533 LINSTROM DR
BATON ROUGE LA
70814-7337
US

IV. Provider business mailing address

PO BOX 318021
BATON ROUGE LA
70831-8021
US

V. Phone/Fax

Practice location:
  • Phone: 225-610-9447
  • Fax:
Mailing address:
  • Phone: 225-610-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number6203237
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number6203237
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: