Provider Demographics
NPI:1851378541
Name:FELL, NISSA L (FNP)
Entity type:Individual
Prefix:
First Name:NISSA
Middle Name:L
Last Name:FELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NISSA
Other - Middle Name:L
Other - Last Name:STOLP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:800 W COLLEGE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-1498
Mailing Address - Country:US
Mailing Address - Phone:507-933-7630
Mailing Address - Fax:507-933-6074
Practice Address - Street 1:6000 EARLE BROWN DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2506
Practice Address - Country:US
Practice Address - Phone:952-993-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1472284363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily