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NPI Code Detail

MEDICARE: DIANA L NELSON PA

MEDICARE: DIANA L NELSON PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant9613MN
2363AM0700XMedical Physician Assistant1406IA
3363A00000XPhysician Assistant9613MN

General Provider Information

NPI Number : 1316941834
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA L NELSON PA
Provider Business Mailing Address
First Line : 404 W FOUNTAIN ST
Second Line :
City : ALBERT LEA
State : MN
Zip : 56007-2437
Country : US
Telephone Number : 507-373-2384
Fax Number :
Provider Business Practice Location Address
First Line : 1000 1ST DR NW
Second Line :
City : AUSTIN
State : MN
Zip : 55912-2941
Country : US
Telephone Number : 507-433-7351
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 09/28/2020

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Directions to “ DIANA L NELSON PA” Practice Location

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