Healthcare Provider Details

I. General information

NPI: 1528251626
Provider Name (Legal Business Name): GERALD BOYD NELSON JR. OPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NORTHWAY DR
SAINT CLOUD MN
56303-4555
US

IV. Provider business mailing address

1555 NORTHWAY DR
SAINT CLOUD MN
56303-4555
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-7807
  • Fax: 320-259-8044
Mailing address:
  • Phone: 320-257-7807
  • Fax: 320-259-8044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: