Provider Demographics
NPI:1730631821
Name:NELSON, JANET
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1169 ROCKLICK BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25555-8148
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1169 ROCKLICK BRANCH RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:WV
Practice Address - Zip Code:25555-8148
Practice Address - Country:US
Practice Address - Phone:304-544-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV47613163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool