Healthcare Provider Details

I. General information

NPI: 1902762040
Provider Name (Legal Business Name): CARTER NELSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 2ND AVE NW
PLAINVIEW MN
55964-1222
US

IV. Provider business mailing address

2206 DOUGLAS TRAIL DR SE
PINE ISLAND MN
55963-2820
US

V. Phone/Fax

Practice location:
  • Phone: 507-272-2384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2525885
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: