Healthcare Provider Details

I. General information

NPI: 1124356928
Provider Name (Legal Business Name): SHELLEY W NELSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2009
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 OLYMPIC ST
SPRINGFIELD OR
97477-3413
US

IV. Provider business mailing address

2874 RIVERWALK LOOP
EUGENE OR
97401-1506
US

V. Phone/Fax

Practice location:
  • Phone: 541-682-3550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number090000504RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: