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General NPI Number Information
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NPI Number | 1093729873
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Entity Type | Individual
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Provider Name | MICHELE K NELSEN MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 14410 SE PETROVITSKY RD STE 104
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City | RENTON
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State | WA
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Zip | 98058-8900
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Country | US
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Telephone | 256-903-4054
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Fax | 425-690-9405
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Provider Business Mailing Address
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Address Line | 3600 LIND AVE SW STE 100 ATTN CREDENTIALING
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City | RENTON
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State | WA
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Zip | 98057-4970
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Country | US
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Telephone | 425-690-2715
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VX0000X
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Taxonomy Name | Obstetrics Physician
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License Number | MD00035357
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00035357
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License Number State | WA
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