Healthcare Provider Details

I. General information

NPI: 1669623906
Provider Name (Legal Business Name): TANISHA MEKLA NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANISHA MEKLA ROBINSON RN

II. Dates (important events)

Enumeration Date: 10/06/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 LORETTO AVE
PHILADELPHIA PA
19111-3847
US

IV. Provider business mailing address

7339 LORETTO AVE
PHILADELPHIA PA
19111-3847
US

V. Phone/Fax

Practice location:
  • Phone: 215-778-9972
  • Fax: 215-364-0851
Mailing address:
  • Phone: 215-778-9972
  • Fax: 215-364-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number523427L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: