Individual
GUERLINE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
454 E 25TH ST, BROOKLYN, NY 11226-7702
(347) 204-2758
Mailing address
454 E 25TH ST, BROOKLYN, NY 11226-7702
(347) 204-2758
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
182935
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
NY
Enumeration date
08/22/2018
Last updated
08/22/2018
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