Provider Demographics
NPI:1346546546
Name:NELSON, VICKI DAUNELLE (APNP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:DAUNELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-9614
Mailing Address - Country:US
Mailing Address - Phone:920-745-3590
Mailing Address - Fax:
Practice Address - Street 1:790 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-9614
Practice Address - Country:US
Practice Address - Phone:920-745-3590
Practice Address - Fax:920-745-7899
Is Sole Proprietor?:No
Enumeration Date:2011-02-04
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4341-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4341-33OtherAPNP