Provider Demographics
NPI:1427454990
Name:NELSON, WANDA MARIE (RDH, MS, NBC-HWC)
Entity type:Individual
Prefix:MS
First Name:WANDA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RDH, MS, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WONDY WAY
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06811
Mailing Address - Country:US
Mailing Address - Phone:203-788-7589
Mailing Address - Fax:
Practice Address - Street 1:36 WONDY WAY
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06811
Practice Address - Country:US
Practice Address - Phone:203-788-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018979-1124Q00000X
NH03028124Q00000X
IDA-3159986171400000X
CT004619124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No171400000XOther Service ProvidersHealth & Wellness Coach