Provider Demographics
NPI:1306131818
Name:NELSON, JANESSA CAPRI (A1C, MBA)
Entity type:Individual
Prefix:MRS
First Name:JANESSA
Middle Name:CAPRI
Last Name:NELSON
Suffix:
Gender:F
Credentials:A1C, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35135
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-0635
Mailing Address - Country:US
Mailing Address - Phone:314-495-0117
Mailing Address - Fax:314-521-3428
Practice Address - Street 1:210 N DADE AVE
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-1825
Practice Address - Country:US
Practice Address - Phone:314-495-0117
Practice Address - Fax:314-521-3428
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172V00000XOther Service ProvidersCommunity Health Worker