Provider Demographics
NPI:1104540962
Name:NELSON, SHANICE
Entity type:Individual
Prefix:
First Name:SHANICE
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 1:605 SCHOLAR HOUSE CT APT 301
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1879
Mailing Address - Country:US
Mailing Address - Phone:502-457-6153
Mailing Address - Fax:
Practice Address - Street 1:801 BARRET AVE STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1747
Practice Address - Country:US
Practice Address - Phone:502-457-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)