Debra Ann Nelson, LPN
Individual provider Active NPI Physical Disabilities Residential Treatment Facility · Rudolph, WI
NPI 1821493479 · NPPES record last updated Oct 24, 2014
Key facts
- NPI
- 1821493479
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Disabilities Residential Treatment Facility 320700000X
- License
- 317774-31 (WI)
- Practice address
- 2271 Pine Rd
Rudolph, WI 54475 - Phone
- (715) 424-4671
- NPI assigned
- Oct 24, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 317774-31 | WI | MD | Physical Disabilities Residential Treatment Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Disabilities Residential Treatment Facility | 320700000X | 317774-31 | WI | Yes |
Addresses
Primary practice location
2271 Pine Rd
Rudolph, WI 54475
Mailing address
2271 Pine Rd
Rudolph, WI 54475
Phone (715) 424-4671
Other providers in Rudolph, WI
All providers in Rudolph, WI · Physical Disabilities Residential Treatment Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.