Healthcare Provider Details

I. General information

NPI: 1851626725
Provider Name (Legal Business Name): NICOLE MARIE NELSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2009
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 STAGELINE RD
HUDSON WI
54016-1793
US

IV. Provider business mailing address

8170 33RD AVE S MAILSTOP 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 715-531-6000
  • Fax:
Mailing address:
  • Phone: 952-883-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95577
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8951-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number324
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: