Provider Demographics
NPI:1013130228
Name:NELSON, FAYLENE M (RNC, IBCLC)
Entity Type:Individual
Prefix:
First Name:FAYLENE
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:RNC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 KARMEN RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7310
Mailing Address - Country:US
Mailing Address - Phone:406-443-0939
Mailing Address - Fax:
Practice Address - Street 1:1639 KARMEN RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7310
Practice Address - Country:US
Practice Address - Phone:406-443-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN16344163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant