MEDICARE: ALEXIS 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1902318215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS NELSON

Provider Business Mailing Address
First Line	:	16574 HUNTINGTON RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-4072
Country	:	US
Telephone Number	:	734-642-5197
Fax Number	:

Provider Business Practice Location Address
First Line	:	17597 STOEPEL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48221-2646
Country	:	US
Telephone Number	:	734-642-5197
Fax Number	:

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

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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Directions to “ ALEXIS NELSON ” Practice Location

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