Provider Demographics
NPI:1114748191
Name:NELSON, RAMONA LARESA (RN)
Entity type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:LARESA
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:RAMONA
Other - Middle Name:LARESA
Other - Last Name:MADISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:208 KNIGHT VALLEY CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-3165
Mailing Address - Country:US
Mailing Address - Phone:803-331-8023
Mailing Address - Fax:
Practice Address - Street 1:CMR 454 BOX 1905
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09250-1020
Practice Address - Country:US
Practice Address - Phone:803-331-8023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC229325163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse