Healthcare Provider Details

I. General information

NPI: 1316259716
Provider Name (Legal Business Name): CHALSEY NELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 N BROADWAY ST
SPRING VALLEY MN
55975-1029
US

IV. Provider business mailing address

PO BOX 232
SPRING VALLEY MN
55975-0232
US

V. Phone/Fax

Practice location:
  • Phone: 507-346-7291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12844
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: