MEDICARE: CANDICE L NELSON MD

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
1	208000000X	Pediatrics Physician	4890	SD
2	208000000X	Pediatrics Physician	R-5860	IA

General Provider Information

NPI Number	:	1629024997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE L NELSON MD

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-312-7605
Fax Number	:	605-312-7611

Provider Business Practice Location Address
First Line	:	6101 S LOUISE AVE
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-5981
Country	:	US
Telephone Number	:	605-312-8000
Fax Number	:	605-312-8001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/27/2020

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