Provider Demographics
NPI:1104635101
Name:ROWELL, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:ROWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 MCDERMOTT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-4922
Mailing Address - Country:US
Mailing Address - Phone:281-857-1288
Mailing Address - Fax:
Practice Address - Street 1:13919 MCDERMOTT DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-4922
Practice Address - Country:US
Practice Address - Phone:281-857-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1235519216Medicaid