Provider Demographics
NPI:1083008924
Name:NELSON, BRADLEY EUGENE (CNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EUGENE
Last Name:NELSON
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 SHINGLE CREEK PKWY
Mailing Address - Street 2:STE 250
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2107
Mailing Address - Country:US
Mailing Address - Phone:763-544-0696
Mailing Address - Fax:763-544-0696
Practice Address - Street 1:6200 SHINGLE CREEK PKWY
Practice Address - Street 2:STE 250
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2107
Practice Address - Country:US
Practice Address - Phone:763-544-0696
Practice Address - Fax:763-544-0696
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY671723163W00000X
NYF307678363LG0600X
MN8806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology