Provider Demographics
NPI:1407534795
Name:NELSON, KRISTIN RAE (DNP, CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 10TH AVE NE APT 1
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3516
Mailing Address - Country:US
Mailing Address - Phone:701-261-4449
Mailing Address - Fax:
Practice Address - Street 1:430 OXFORD ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6092
Practice Address - Country:US
Practice Address - Phone:701-261-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR44555367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered