Provider Demographics
NPI:1316035926
Name:NELSON, CHRISTINA RAE CORNISH (LAC, MAOM)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:RAE CORNISH
Last Name:NELSON
Suffix:
Gender:F
Credentials:LAC, MAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1520 S MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETER
Mailing Address - State:MN
Mailing Address - Zip Code:56082-2212
Mailing Address - Country:US
Mailing Address - Phone:507-934-3333
Mailing Address - Fax:507-934-3555
Practice Address - Street 1:1520 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-2212
Practice Address - Country:US
Practice Address - Phone:507-934-3333
Practice Address - Fax:507-934-3555
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1295171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist