Doctor Name: | RENAE JEAN NELSON |
NPI Number: | 1306293428 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 107490 |
Business Practice Address: | 5322 South Big Lake Road Big Lake, AK - 99652 |
Business Phone Number: | 9078921628 |
Business Fax Number: | 9078921629 |
Mailing Address: | Po Box 521833, BIG LAKE |
State: | AK |
Postal Code: | 996521833 |
Phone Number: | 9078921628 |
Fax Number: | 9078921629 |
NPI Enumeration Date: | 05/18/2016 |
NPI Last Update Date: | 05/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | 107490 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |