Provider Demographics
NPI:1447670104
Name:NELSON, TARA (MD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1414 MARYLAND AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2824
Mailing Address - Country:US
Mailing Address - Phone:651-793-5613
Mailing Address - Fax:651-495-0499
Practice Address - Street 1:6939 PINE ARBOR DR S STE 100
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4643
Practice Address - Country:US
Practice Address - Phone:651-326-5800
Practice Address - Fax:651-326-5802
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
MN59506207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine