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NPI Code Detail

MEDICARE: TIFFANY NELSON

MEDICARE: TIFFANY 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1235606476
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY NELSON
Provider Business Mailing Address
First Line : 1825 PRAIRIE CITY RD
Second Line :
City : FOLSOM
State : CA
Zip : 95630-9578
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1825 PRAIRIE CITY RD
Second Line :
City : FOLSOM
State : CA
Zip : 95630-9578
Country : US
Telephone Number : 303-989-8169
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2018
Last Update Date : 04/20/2023

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Directions to “ TIFFANY NELSON ” Practice Location

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