Provider Demographics
NPI:1386994325
Name:NELSON, STACY K (APRN-NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:K
Last Name:NELSON
Suffix:
Gender:F
Credentials:APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N 29TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4424
Mailing Address - Country:US
Mailing Address - Phone:402-844-8284
Mailing Address - Fax:402-844-8175
Practice Address - Street 1:110 N 29TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4424
Practice Address - Country:US
Practice Address - Phone:402-844-8284
Practice Address - Fax:402-844-8175
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111362363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care