MEDICARE: MRS. MICHELLE M NELSON MSN, FNP-BC

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	363LC1500X	Community Health Nurse Practitioner	R120703-5	MN
2	363LF0000X	Family Nurse Practitioner	R120703-5	MN
3	363LF0000X	Family Nurse Practitioner	3093	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700846052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE M NELSON MSN, FNP-BC

Provider Business Mailing Address
First Line	:	760 W 4TH ST
Second Line	:
City	:	RUSH CITY
State	:	MN
Zip	:	55069-9063
Country	:	US
Telephone Number	:	320-358-4784
Fax Number	:	320-358-4665

Provider Business Practice Location Address
First Line	:	5366 386TH ST NE
Second Line	:
City	:	NORTH BRANCH
State	:	MN
Zip	:	55056-5833
Country	:	US
Telephone Number	:	651-674-8353
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	11/28/2023

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