Healthcare Provider Details

I. General information

NPI: 1699335703
Provider Name (Legal Business Name): TOWANA MONIQUE NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37490 DEQUINDRE RD
STERLING HEIGHTS MI
48310-3503
US

IV. Provider business mailing address

25224 HOOVER RD APT 202
WARREN MI
48089-1122
US

V. Phone/Fax

Practice location:
  • Phone: 586-480-1438
  • Fax: 586-983-9797
Mailing address:
  • Phone: 702-487-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704-164648
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: