Provider Demographics
NPI:1699335703
Name:NELSON, TOWANA MONIQUE (RN)
Entity type:Individual
Prefix:
First Name:TOWANA
Middle Name:MONIQUE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25224 HOOVER RD APT 202
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48089-1122
Mailing Address - Country:US
Mailing Address - Phone:702-487-0139
Mailing Address - Fax:
Practice Address - Street 1:37490 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-3503
Practice Address - Country:US
Practice Address - Phone:586-480-1438
Practice Address - Fax:586-983-9797
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704-164648163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health