Provider Demographics
NPI:1588625107
Name:NELSON, SANDRA L (CPNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:NELSON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-4340
Mailing Address - Fax:515-643-2784
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8457
Practice Address - Country:US
Practice Address - Phone:515-643-2600
Practice Address - Fax:515-643-4733
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121268363LP0200X
MNR 089542-2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN641042100Medicaid
MN641042100Medicaid