Provider Demographics
NPI:1184044968
Name:NELSON, JOSEPH ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:NELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8053 E BLOOMINGTON FWY STE 450
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-1031
Mailing Address - Country:US
Mailing Address - Phone:612-376-7708
Mailing Address - Fax:
Practice Address - Street 1:8053 E BLOOMINGTON FWY STE 450
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-1031
Practice Address - Country:US
Practice Address - Phone:612-376-7708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61320199207Q00000X
ARE-14883207Q00000X
NC2021-02781207Q00000X
IL036158248207Q00000X
OK38537207Q00000X
NE33959207Q00000X
PAMD475790207Q00000X
MO2021045545207Q00000X
CT72074207Q00000X
MIEMC0002092207Q00000X
MTMED-PHYS-LIC-111758207Q00000X
GA92908207Q00000X
TXQ9211207Q00000X
MN71884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2021-02781OtherNORTH CAROLINA LICENSE
PAMD475790OtherPENNSYLVANIA LICENSE
IL036158248OtherILLINOIS LICENSE
WAMD61320199OtherWASHINGTON LICENSE
TXQ9211OtherMEDICAL LICENSE
MO2021045545OtherMISSOURI LICENSE
MIEMC0002092OtherMICHIGAN LICENSE
CT72074OtherCONNETICUT LICENSE
MTMED-PHYS-LIC-111758OtherMONTANA LICENSE
NE33959OtherNEBRASKA LICENSE
MN71884OtherMINNESOTA LICENSE
GA92908OtherGEORGIA LICENSE
OK38537OtherOKLAHOMA LICENSE
ARE-14883OtherARKANSAS LICENSE
OKFN6292217OtherOK DEA
OK38537OtherOKLAHOMA LICENSE
ARE-14883OtherARKANSAS LICENSE