Provider Demographics
NPI:1073291555
Name:NELSON, ABIGAIL MARIE (RN BSN)
Entity Type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MS
Other - First Name:ABIGAIL
Other - Middle Name:MARIE
Other - Last Name:COURTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN ADN
Mailing Address - Street 1:567 MITCHELL ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53508-9022
Mailing Address - Country:US
Mailing Address - Phone:920-410-7060
Mailing Address - Fax:
Practice Address - Street 1:567 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53508-9022
Practice Address - Country:US
Practice Address - Phone:920-410-7060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI243198-30163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty