Provider Demographics
NPI:1053797241
Name:NELSON, TANELLE (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MISS
First Name:TANELLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 SCHALLER ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-5656
Mailing Address - Country:US
Mailing Address - Phone:608-371-3142
Mailing Address - Fax:
Practice Address - Street 1:2610 SCHALLER ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-5656
Practice Address - Country:US
Practice Address - Phone:608-371-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10071-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist