Provider Demographics
NPI:1073133633
Name:NELSON, JAMES DOUGLAS II (RN)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:NELSON
Suffix:II
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1538
Mailing Address - Country:US
Mailing Address - Phone:320-296-2212
Mailing Address - Fax:
Practice Address - Street 1:1902 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1538
Practice Address - Country:US
Practice Address - Phone:320-296-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2149464163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health