Basic Information
| Provider Information | |||||||||
| NPI: | 1659960524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | BRENDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11 RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | HICKORY CREEK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750652927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419792109 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8001 S US HIGHWAY 75 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750905707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035321400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2021 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9271830 | FL | Y | Nursing Service Providers | Registered Nurse |
No ID Information.