Healthcare Provider Details

I. General information

NPI: 1205746054
Provider Name (Legal Business Name): SAMANTHA MARIE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WEATHER RIDGE RD APT 3
CHIPPEWA FALLS WI
54729-5425
US

IV. Provider business mailing address

1120 WEATHER RIDGE RD APT 3
CHIPPEWA FALLS WI
54729-5425
US

V. Phone/Fax

Practice location:
  • Phone: 715-607-1483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: