Provider Demographics
NPI:1104339399
Name:NELSON, KELSEY MARIE KIM (RN)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE KIM
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21050 NEWBERRY AVE N
Mailing Address - Street 2:
Mailing Address - City:SCANDIA
Mailing Address - State:MN
Mailing Address - Zip Code:55073-9103
Mailing Address - Country:US
Mailing Address - Phone:651-558-6259
Mailing Address - Fax:
Practice Address - Street 1:21050 NEWBERRY AVE N
Practice Address - Street 2:
Practice Address - City:SCANDIA
Practice Address - State:MN
Practice Address - Zip Code:55073-9103
Practice Address - Country:US
Practice Address - Phone:651-558-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2457026163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse