MEDICARE: NATHANIEL FOREVER NELSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1154257814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHANIEL FOREVER NELSON

Provider Business Mailing Address
First Line	:	3408 RICHMOND BLVD APT 206
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-5853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4319 PIEDMONT AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94611-4755
Country	:	US
Telephone Number	:	847-924-2751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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Directions to “ NATHANIEL FOREVER NELSON ” Practice Location

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