Healthcare Provider Details

I. General information

NPI: 1235845736
Provider Name (Legal Business Name): ALEXIS LEIGH NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PRIVATE 977
PEDRO OH
45659-8608
US

IV. Provider business mailing address

103 4TH ST E APT 4
SOUTH POINT OH
45680-9403
US

V. Phone/Fax

Practice location:
  • Phone: 740-534-1386
  • Fax:
Mailing address:
  • Phone: 740-716-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: