Provider Demographics
NPI:1134282940
Name:NELSON, KIRSTEN RUTH MARTINSON (MD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:RUTH MARTINSON
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:RUTH
Other - Last Name:MARTINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:17580 COLONIAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2209
Mailing Address - Country:US
Mailing Address - Phone:719-487-0617
Mailing Address - Fax:
Practice Address - Street 1:17580 COLONIAL PARK DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-2209
Practice Address - Country:US
Practice Address - Phone:719-487-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42920208000000X
MN39585208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86364Medicare UPIN