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NPI Code Detail

MEDICARE: JOHN NELSON PMHNP

MEDICARE: JOHN NELSON PMHNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner17849-33WI

General Provider Information

NPI Number : 1194682021
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN NELSON PMHNP
Provider Business Mailing Address
First Line : 3244 S ELMWOOD AVE
Second Line :
City : GREENFIELD
State : WI
Zip : 53219-4712
Country : US
Telephone Number : 414-745-2764
Fax Number :
Provider Business Practice Location Address
First Line : 7330 W LAYTON AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53220-3849
Country : US
Telephone Number : 414-877-4570
Fax Number : 414-281-9884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2026
Last Update Date : 01/05/2026

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