Provider Demographics
NPI:1992176424
Name:NELSON, MERCEDEZ
Entity type:Individual
Prefix:
First Name:MERCEDEZ
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 UTICA RIDGE RD SUITE 4
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-2478
Mailing Address - Country:US
Mailing Address - Phone:563-326-1400
Mailing Address - Fax:563-326-0700
Practice Address - Street 1:3740 UTICA RIDGE RD SUITE 4
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-2478
Practice Address - Country:US
Practice Address - Phone:563-326-1400
Practice Address - Fax:563-326-0700
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079070225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist