Basic Information
| Provider Information | |||||||||
| NPI: | 1003153016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | MARK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3725 CLEVELAND MASSILLON RD | ||||||||
| Address2: | STE 7A | ||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442035614 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 3725 CLEVELAND MASSILLON RD | ||||||||
| Address2: | STE 7A | ||||||||
| City: | NORTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442035614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307060446 | ||||||||
| FaxNumber: | 3307060465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2013 | ||||||||
| LastUpdateDate: | 01/10/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 2744 | OH | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.