Provider Demographics
NPI:1902357668
Name:NELSON, RACHEL MECEDES
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MECEDES
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 UPPER 205TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6832
Mailing Address - Country:US
Mailing Address - Phone:952-454-2517
Mailing Address - Fax:
Practice Address - Street 1:9750 UPPER 205TH ST W
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6832
Practice Address - Country:US
Practice Address - Phone:952-454-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235012-7163W00000X
IA137895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse