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NPI Code Detail

MEDICARE: BRADLEY EUGENE NELSON CNP

MEDICARE: BRADLEY EUGENE NELSON CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse671723NY
2363LG0600XGerontology Nurse PractitionerF307678NY
3363L00000XNurse Practitioner8806MN

General Provider Information

NPI Number : 1083008924
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY EUGENE NELSON CNP
Provider Business Mailing Address
First Line : 6200 SHINGLE CREEK PKWY
Second Line : STE 250
City : BROOKLYN CENTER
State : MN
Zip : 55430-2107
Country : US
Telephone Number : 763-544-0696
Fax Number : 763-544-0696
Provider Business Practice Location Address
First Line : 6200 SHINGLE CREEK PKWY
Second Line : STE 250
City : BROOKLYN CENTER
State : MN
Zip : 55430-2107
Country : US
Telephone Number : 763-544-0696
Fax Number : 763-544-0696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2015
Last Update Date : 05/10/2022

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Directions to “ BRADLEY EUGENE NELSON CNP” Practice Location

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