Healthcare Provider Details

I. General information

NPI: 1487591848
Provider Name (Legal Business Name): RENEE VERONICA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 18TH ST NW
CANTON OH
44703-1050
US

IV. Provider business mailing address

1438 18TH ST NW
CANTON OH
44703-1050
US

V. Phone/Fax

Practice location:
  • Phone: 330-413-5055
  • Fax:
Mailing address:
  • Phone: 330-413-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: