Provider Demographics
NPI:1215532932
Name:NELSON, DENNIS PERNELL
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:PERNELL
Last Name:NELSON
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 1:9448 MARLFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-3322
Mailing Address - Country:US
Mailing Address - Phone:804-815-9277
Mailing Address - Fax:
Practice Address - Street 1:9448 MARLFIELD RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-3322
Practice Address - Country:US
Practice Address - Phone:804-815-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT67-58-30-0166343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)