Healthcare Provider Details

I. General information

NPI: 1609732395
Provider Name (Legal Business Name): CHRISTINA NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINA YUTZY

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4019 SELNIK RD
KENT OH
44240-6411
US

IV. Provider business mailing address

4019 SELNIK RD
KENT OH
44240-6411
US

V. Phone/Fax

Practice location:
  • Phone: 330-701-5838
  • Fax:
Mailing address:
  • Phone: 330-701-5838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: