Healthcare Provider Details

I. General information

NPI: 1942227442
Provider Name (Legal Business Name): PETER J NELSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 BAUMGARTNER DR
LA CROSSE WI
54603-8503
US

IV. Provider business mailing address

2605 BAUMGARTNER DR
LA CROSSE WI
54603-8503
US

V. Phone/Fax

Practice location:
  • Phone: 608-781-1401
  • Fax:
Mailing address:
  • Phone: 608-781-1401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number22474-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: