Individual
DEVAN TYLER NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
221 NE GLEN OAK AVE, PEORIA, IL 61636-0001
(309) 671-8308
Mailing address
1004 N 123RD ST, WAUWATOSA, WI 53226-3316
(414) 943-6199
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
390200000X
—
Other
Enumeration date
04/02/2025
Last updated
04/02/2025
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