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NPI Code Detail

MEDICARE: MS. LORI ANN NELSON MSED, LP

MEDICARE: MS. LORI ANN NELSON MSED, LP
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
1103T00000XPsychologistLP3099MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110216OTHERUCARE
2411768605OTHERCERIDIAN
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
46262609OTHERUBH MEDICA SELECT CARE
582D17NEOTHERBCBS COMP CARE
62315034OTHERAMERICAS PPO
7766591015131OTHERPREFERRED ONE
8187408OTHERMAYO MANAGEMENT
9337324OTHERVALUE OPTIONS

General Provider Information

NPI Number : 1902888555
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LORI ANN NELSON MSED, LP
Provider Business Mailing Address
First Line : 600 25TH AVE S
Second Line : STE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Provider Business Practice Location Address
First Line : 600 25TH AVE S
Second Line : STE 109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 06/07/2017

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