Provider Demographics
NPI:1871727263
Name:NELSON, CARRIE ANN (RN)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2827
Mailing Address - Country:US
Mailing Address - Phone:218-590-1655
Mailing Address - Fax:
Practice Address - Street 1:728 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2634
Practice Address - Country:US
Practice Address - Phone:218-722-8180
Practice Address - Fax:218-727-9555
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNRN-R 151799-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse