MEDICARE: DANYELLE 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	374U00000X	Home Health Aide		MO

General Provider Information

NPI Number	:	1225585631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYELLE NELSON

Provider Business Mailing Address
First Line	:	111-119 CHURCH ST
Second Line	:	SUITE 104-105
City	:	FERGUSON
State	:	MO
Zip	:	63135-2441
Country	:	US
Telephone Number	:	314-736-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	111-119 CHURCH ST
Second Line	:	SUITE 104-105
City	:	FERGUSON
State	:	MO
Zip	:	63135-2441
Country	:	US
Telephone Number	:	314-736-1388
Fax Number	:

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

Provider Enumeration Date	:	09/01/2016
Last Update Date	:	09/01/2016

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Directions to “ DANYELLE NELSON ” Practice Location

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