Provider Demographics
NPI:1962204099
Name:NELSON, CHARLOTTE FRANCES (APRN)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:FRANCES
Last Name:NELSON
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COOPER DR
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:MT
Mailing Address - Zip Code:59421-8406
Mailing Address - Country:US
Mailing Address - Phone:210-630-1886
Mailing Address - Fax:
Practice Address - Street 1:500 W BROADWAY ST STE 320
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4003
Practice Address - Country:US
Practice Address - Phone:406-329-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT259469363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner