Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | R120703-5 | MN |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R120703-5 | MN |
NPI | 1700846052 |
---|---|
Provider Name | Mrs. Michelle M Nelson |
First Address | Rush City, MN 55069-9063 |
Second Address | Rush City, MN 55069-9063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 04/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
560650100 | (05) | MN |
S39636 | (02) |