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General NPI Number Information
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NPI Number | 1376322784
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Entity Type | Individual
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Provider Name | NICOLE LYNNE NELSON DNP, CRNA
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Gender | Female
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 05/28/2024
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Provider Practice Location Address
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Address Line | 835 S VAN BUREN ST
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City | GREEN BAY
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State | WI
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Zip | 54301-3526
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Country | US
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Telephone | 920-433-0111
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Fax |
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Provider Business Mailing Address
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Address Line | N6065 COUNTY ROAD U
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City | DE PERE
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State | WI
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Zip | 54115-8903
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Country | US
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Telephone |
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 236230-30
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 151951
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License Number State | WI
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