Provider Demographics
NPI:1316438757
Name:NELSON, CARLY ELIZABETH (LPN)
Entity type:Individual
Prefix:MS
First Name:CARLY
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 244
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MI
Mailing Address - Zip Code:49871-0244
Mailing Address - Country:US
Mailing Address - Phone:906-361-2293
Mailing Address - Fax:
Practice Address - Street 1:2292 US HIGHWAY 41 W STE 6
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2482
Practice Address - Country:US
Practice Address - Phone:906-228-4204
Practice Address - Fax:855-261-2633
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703100821164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse