Healthcare Provider Details

I. General information

NPI: 1255373478
Provider Name (Legal Business Name): MRS. ROBIN R NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 LEWIS RD NW
MANDAN ND
58554-1362
US

IV. Provider business mailing address

3809 LEWIS RD NW
MANDAN ND
58554-1362
US

V. Phone/Fax

Practice location:
  • Phone: 701-663-1900
  • Fax:
Mailing address:
  • Phone: 701-663-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number172
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: