Individual ProviderTiesha Marie NelsonLicensed Practical NurseNursing Service ProvidersPractice Address202 Boot Hill Ct, Amityville, NY 11701-2202(404) 641-8422PECOS EnrollmentBased on the most recent information from CMS, provider Tiesha Marie Nelson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1326226762Provider TypeIndividualFull NameNelson, Tiesha MarieCredentialLPNGenderFemaleSole ProprietorYesEnumeration Date2/7/2008Last Updated2/7/2008Contact InformationPractice LocationPractice Address202 Boot Hill Ct, Amityville, NY 11701-2202Phone(404) 641-8422FaxUnlisted FaxMailing LocationMailing Address202 Boothill Court, Amityville, NY 11701Phone(404) 641-8422FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164W00000XPrimaryDescriptionLicensed Practical NurseNursing Service ProvidersLicense283333-1New York