Healthcare Provider Details

I. General information

NPI: 1851363923
Provider Name (Legal Business Name): DEBORAH NELSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 W FAIDLEY AVE
GRAND ISLAND NE
68803-4671
US

IV. Provider business mailing address

PO BOX 157
SHELTON NE
68876-0157
US

V. Phone/Fax

Practice location:
  • Phone: 308-384-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNE1712
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: