Provider Demographics
NPI: | 1659628469 |
---|---|
Name: | NELSON, INGRID (APRN) |
Entity Type: | Individual |
Prefix: | |
First Name: | INGRID |
Middle Name: | |
Last Name: | NELSON |
Suffix: | |
Gender: | F |
Credentials: | APRN |
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 776351 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60677-6351 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 502-588-9490 |
Mailing Address - Fax: | 502-272-5116 |
Practice Address - Street 1: | 2360 STONY BROOK DR |
Practice Address - Street 2: | |
Practice Address - City: | LOUISVILLE |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40220-4018 |
Practice Address - Country: | US |
Practice Address - Phone: | 502-446-5462 |
Practice Address - Fax: | 502-394-3670 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2012-08-10 |
Last Update Date: | 2020-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
KY | 3007526 | 363LP2300X, 363L00000X, 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | |
No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |