Provider Demographics
NPI:1003823410
Name:NELSON, CAROL B (MD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:B
Last Name:NELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 N SANBORN BLVD
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-1015
Mailing Address - Country:US
Mailing Address - Phone:605-941-6363
Mailing Address - Fax:
Practice Address - Street 1:1415 N SANBORN BLVD
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-1015
Practice Address - Country:US
Practice Address - Phone:605-990-2178
Practice Address - Fax:605-990-2179
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD39982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN03A66MIOtherBCBS
IA0004102OtherBCBS
SD6100440Medicaid
SD0004102OtherBCBS
IA0992172Medicaid
MN825523700Medicaid
G16833Medicare UPIN
IA0004102OtherBCBS
SD130012800Medicare ID - Type UnspecifiedRAILROAD
SD6100440Medicaid