Provider Demographics
NPI:1174266159
Name:NELSON, KATLYN B
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:B
Other - Last Name:RAMSDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2209
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-2209
Mailing Address - Country:US
Mailing Address - Phone:701-857-0715
Mailing Address - Fax:701-857-0756
Practice Address - Street 1:225 3RD ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-857-0715
Practice Address - Fax:701-857-0756
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist