Provider Demographics
NPI:1154783934
Name:NELSON, MICHELLE (BSN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28798 E YELLOW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-8340
Mailing Address - Country:US
Mailing Address - Phone:651-283-1518
Mailing Address - Fax:
Practice Address - Street 1:28798 E YELLOW RIVER RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:WI
Practice Address - Zip Code:54830-8340
Practice Address - Country:US
Practice Address - Phone:651-283-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148053-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse