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NPI Code Detail

MEDICARE: CSILLA H NELSON

MEDICARE: CSILLA H 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
1247200000XOther Technician

General Provider Information

NPI Number : 1639663164
Entity Type Code : Individual
Provider Name (Legal Business Name) : CSILLA H NELSON
Provider Business Mailing Address
First Line : 4575 SE DIXIE HWY
Second Line :
City : STUART
State : FL
Zip : 34997-6826
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 67 HIKER ST
Second Line :
City : SANTA ROSA BEACH
State : FL
Zip : 32459-8826
Country : US
Telephone Number : 855-832-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2018
Last Update Date : 06/18/2018

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Directions to “ CSILLA H NELSON ” Practice Location

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