Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R41829 | ND |
N | 363LF0000X | Nurse Practitioner - Family Medicine | R41829 | MN |
NPI | 1003472317 |
---|---|
Provider Name | Sadie Marie Nelson |
First Address | Fargo, ND 58102 |
Second Address | Fargo, ND 58102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2019 |
Last Update Date | 06/08/2019 |