Provider Demographics
NPI:1326704164
Name:TACHI, NELSON
Entity type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:TACHI
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 1:13830 CASTLE BLVD APT 302
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-7366
Mailing Address - Country:US
Mailing Address - Phone:024-362-2162
Mailing Address - Fax:
Practice Address - Street 1:13830 CASTLE BLVD APT 302
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7366
Practice Address - Country:US
Practice Address - Phone:024-362-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00198962376K00000X
DCHHA200002151374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide