Healthcare Provider Details

I. General information

NPI: 1700846052
Provider Name (Legal Business Name): MICHELLE M NELSON MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5366 386TH ST NE
NORTH BRANCH MN
55056-5833
US

IV. Provider business mailing address

760 W 4TH ST
RUSH CITY MN
55069-9063
US

V. Phone/Fax

Practice location:
  • Phone: 651-674-8353
  • Fax:
Mailing address:
  • Phone: 320-358-4784
  • Fax: 320-358-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberR120703-5
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR120703-5
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3093
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: