Healthcare Provider Details

I. General information

NPI: 1871727263
Provider Name (Legal Business Name): CARRIE ANN NELSON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 GARFIELD AVE
DULUTH MN
55802-2634
US

IV. Provider business mailing address

1104 N 16TH ST
SUPERIOR WI
54880-2827
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-8180
  • Fax: 218-727-9555
Mailing address:
  • Phone: 218-590-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-R 151799-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: