Provider Demographics
NPI:1528344900
Name:NELLUM, DEMETRIUS (LVN)
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:
Last Name:NELLUM
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 HAYES RD APT 2007
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-6914
Mailing Address - Country:US
Mailing Address - Phone:281-857-1710
Mailing Address - Fax:
Practice Address - Street 1:2101 HAYES RD APT 2007
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-6914
Practice Address - Country:US
Practice Address - Phone:281-857-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS56130376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide