MEDICARE: CARRIE ANN NELSON R.N.

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	RN-R 151799-0	MN

General Provider Information

NPI Number	:	1871727263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE ANN NELSON R.N.

Provider Business Mailing Address
First Line	:	1104 N 16TH ST
Second Line	:
City	:	SUPERIOR
State	:	WI
Zip	:	54880-2827
Country	:	US
Telephone Number	:	218-590-1655
Fax Number	:

Provider Business Practice Location Address
First Line	:	728 GARFIELD AVE
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2634
Country	:	US
Telephone Number	:	218-722-8180
Fax Number	:	218-727-9555

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

Provider Enumeration Date	:	05/13/2009
Last Update Date	:	05/13/2009

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