Healthcare Provider Details

I. General information

NPI: 1164327466
Provider Name (Legal Business Name): MR. STEVE JOSEPH NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13611 E US HIGHWAY 20-26
EVANSVILLE WY
82636-9726
US

IV. Provider business mailing address

13611 E US HIGHWAY 20-26
EVANSVILLE WY
82636-9726
US

V. Phone/Fax

Practice location:
  • Phone: 307-315-8052
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: