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General NPI Number Information
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NPI Number | 1851626725
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Entity Type | Individual
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Provider Name | NICOLE MARIE NELSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 237 RADIO DR STE 200
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City | WOODBURY
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State | MN
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Zip | 55125-4478
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Country | US
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Telephone | 612-871-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 KNOB RD
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55118-4326
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Country | US
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Telephone | 612-990-0674
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 95577
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License Number State | OK
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