Healthcare Provider Details

I. General information

NPI: 1740829845
Provider Name (Legal Business Name): CONNIE RACHELLE NELSON APRN-NP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 O ST STE 300
LINCOLN NE
68510-2647
US

IV. Provider business mailing address

8101 O ST STE 300
LINCOLN NE
68510-2647
US

V. Phone/Fax

Practice location:
  • Phone: 402-856-0034
  • Fax:
Mailing address:
  • Phone: 402-413-5448
  • Fax: 402-858-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number66037
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number113076
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: