Provider Demographics
NPI:1407179955
Name:NELSON-PHELAN, KATRINA (APN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:NELSON-PHELAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NICOLLET MALL
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2530
Mailing Address - Country:US
Mailing Address - Phone:855-925-4733
Mailing Address - Fax:
Practice Address - Street 1:900 NICOLLET MALL
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2530
Practice Address - Country:US
Practice Address - Phone:855-925-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008031363LF0000X
MNCNP 4928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily