Provider Demographics
NPI:1053121194
Name:NELSON, DEJA RAYNE (RN, BSN, DNP STUDENT)
Entity type:Individual
Prefix:
First Name:DEJA
Middle Name:RAYNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, BSN, DNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 E HOLLYHOCK CT
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-8343
Mailing Address - Country:US
Mailing Address - Phone:801-389-1101
Mailing Address - Fax:
Practice Address - Street 1:201 PRESIDENTS CIR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84112-9049
Practice Address - Country:US
Practice Address - Phone:801-389-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10385524-3102163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse