Provider Demographics
NPI:1518604776
Name:NELSON, ANGIE ERICKA (LN, CNS, NBC-HWC)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:ERICKA
Last Name:NELSON
Suffix:
Gender:F
Credentials:LN, CNS, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 HENNEPIN AVE APT 708
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1798
Mailing Address - Country:US
Mailing Address - Phone:612-423-8186
Mailing Address - Fax:
Practice Address - Street 1:1150 HENNEPIN AVE APT 708
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1798
Practice Address - Country:US
Practice Address - Phone:612-423-8186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
136A00000X, 171400000X
MNN242133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
No136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered
No171400000XOther Service ProvidersHealth & Wellness Coach