Provider Demographics
NPI:1629188289
Name:NELSEN, MARCIA K (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:K
Last Name:NELSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:K
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45125 291ST ST
Mailing Address - Street 2:
Mailing Address - City:VIBORG
Mailing Address - State:SD
Mailing Address - Zip Code:57070-5300
Mailing Address - Country:US
Mailing Address - Phone:605-760-3972
Mailing Address - Fax:605-326-5706
Practice Address - Street 1:45125 291ST ST
Practice Address - Street 2:
Practice Address - City:VIBORG
Practice Address - State:SD
Practice Address - Zip Code:57070-5300
Practice Address - Country:US
Practice Address - Phone:605-760-3972
Practice Address - Fax:605-326-5706
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36452207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1939991Medicaid
IAD25154Medicare UPIN
IAI16739Medicare ID - Type Unspecified