MEDICARE: KELSIE NELSON

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	163W00000X	Registered Nurse	R179856-0	MN

General Provider Information

NPI Number	:	1689963969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE NELSON

Provider Business Mailing Address
First Line	:	910 RODEO DR SE
Second Line	:
City	:	PINE ISLAND
State	:	MN
Zip	:	55963-8103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 RODEO DR SE
Second Line	:
City	:	PINE ISLAND
State	:	MN
Zip	:	55963-8103
Country	:	US
Telephone Number	:	218-280-3333
Fax Number	:

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

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	04/07/2011

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Directions to “ KELSIE NELSON ” Practice Location

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