Provider Demographics
NPI:1912199423
Name:NELSON, DALEEN ANN (RN IBCLC)
Entity Type:Individual
Prefix:MS
First Name:DALEEN
Middle Name:ANN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 WINTHROP WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-0012
Mailing Address - Country:US
Mailing Address - Phone:208-568-4900
Mailing Address - Fax:
Practice Address - Street 1:378 WINTHROP WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-0012
Practice Address - Country:US
Practice Address - Phone:208-568-4900
Practice Address - Fax:208-377-8118
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN24776163W00000X
ID104 21342163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant