MEDICARE: BLESSING D NEBEOLISA RN, WCN-C CSWD-C

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	163WW0000X	Wound Care Registered Nurse	894831	TX
2	163W00000X	Registered Nurse	894831	TX

General Provider Information

NPI Number	:	1295698009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLESSING D NEBEOLISA RN, WCN-C CSWD-C

Provider Business Mailing Address
First Line	:	4714 FM 1488 RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-4928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4714 FM 1488 RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77384-4928
Country	:	US
Telephone Number	:	281-673-0725
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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