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NPI Code Detail

MEDICARE: MRS. KRISTA RAE NELSON RN

MEDICARE: MRS. KRISTA RAE NELSON RN
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
1163WS0200XSchool Registered Nurse141522WI

General Provider Information

NPI Number : 1730016023
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTA RAE NELSON RN
Provider Business Mailing Address
First Line : 1700 CHICAGO ST
Second Line :
City : DE PERE
State : WI
Zip : 54115-3418
Country : US
Telephone Number : 920-983-9174
Fax Number : 920-337-1033
Provider Business Practice Location Address
First Line : 1700 CHICAGO ST
Second Line :
City : DE PERE
State : WI
Zip : 54115-3418
Country : US
Telephone Number : 920-983-9174
Fax Number : 920-337-1033
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2026
Last Update Date : 05/08/2026

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