Provider Demographics
NPI:1689290710
Name:NELSON, ABIGAIL JO (NP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JO
Last Name:NELSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-3117
Mailing Address - Country:US
Mailing Address - Phone:701-252-8130
Mailing Address - Fax:701-252-8137
Practice Address - Street 1:122 2ND ST NW
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-3117
Practice Address - Country:US
Practice Address - Phone:701-252-8130
Practice Address - Fax:701-252-8137
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR40298363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily