Individual
DEDRA TAREE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HOME HEALTH
Contact information
Practice address
2808 15TH ST, RACINE, WI 53405-5013
(262) 721-8567
Mailing address
2808 15TH ST, RACINE, WI 53405-5013
(262) 721-8567
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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