Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 104299142 | MN |
N | 363LW0102X | Nurse Practitioner - Women's Health | R 103753-5 | MN |
NPI | 1104012145 |
---|---|
Provider Name | Judy Lynn Nelson |
First Address | St Paul, MN 55116-4409 |
Second Address | Minneapolis, MN 55404-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2007 |
Last Update Date | 05/04/2021 |