Provider Demographics
NPI:1073750113
Name:NELSON, LINDA (RN)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
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 1:1100 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:MI
Mailing Address - Zip Code:49911-1252
Mailing Address - Country:US
Mailing Address - Phone:906-663-4549
Mailing Address - Fax:
Practice Address - Street 1:1100 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:MI
Practice Address - Zip Code:49911-1252
Practice Address - Country:US
Practice Address - Phone:906-663-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204120163W00000X
WI135531-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse