Individual
MRS. TANISHA MEKLA NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
7339 LORETTO AVE, PHILADELPHIA, PA 19111-3847
(215) 778-9972
(215) 364-0851
Mailing address
7339 LORETTO AVE, PHILADELPHIA, PA 19111-3847
(215) 778-9972
(215) 364-0851
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
523427L
PA
246RM2200X
Medical Laboratory Technician
—
PA
Other
Enumeration date
10/06/2008
Last updated
10/06/2008
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