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General NPI Number Information
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NPI Number | 1730696857
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Entity Type | Individual
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Provider Name | BRENDA A NELSON BS, LADC
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Gender | Female
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 155 WABASHA ST S STE 122
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City | SAINT PAUL
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State | MN
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Zip | 55107-1822
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Country | US
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Telephone | 651-227-8224
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Fax | 651-227-8210
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Provider Business Mailing Address
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Address Line | 220 ROBERT ST S STE 104
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City | SAINT PAUL
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State | MN
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Zip | 55107-1626
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Country | US
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Telephone | 651-493-9534
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Fax | 651-340-5332
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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