Provider Demographics
NPI:1962490326
Name:NELSON, CATHERINE MICHELLE (LICENSED PRACTICAL N)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:MICHELLE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LICENSED PRACTICAL N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 VIA FORMIA
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5873
Mailing Address - Country:US
Mailing Address - Phone:941-204-7668
Mailing Address - Fax:
Practice Address - Street 1:1150 VIA FORMIA
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5873
Practice Address - Country:US
Practice Address - Phone:941-204-7668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN 5155491164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse