Provider Demographics
NPI:1497093272
Name:NILSEN, SHERYL LYN (COTA)
Entity Type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:LYN
Last Name:NILSEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 RICE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-4819
Mailing Address - Country:US
Mailing Address - Phone:218-625-6444
Mailing Address - Fax:218-625-6777
Practice Address - Street 1:2501 RICE LAKE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-4819
Practice Address - Country:US
Practice Address - Phone:218-625-6444
Practice Address - Fax:218-625-6777
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN200687314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility