Healthcare Provider Details

I. General information

NPI: 1740940659
Provider Name (Legal Business Name): KATHERINE NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE STE 400
LANSING MI
48912-1806
US

IV. Provider business mailing address

4410 CONGDON DR
WILLIAMSTON MI
48895-9414
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax:
Mailing address:
  • Phone: 517-282-6782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704303676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: