Provider Demographics
NPI:1134177561
Name:NELSON, SUSAN E (RN, FNP)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 NININGER RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1086
Mailing Address - Country:US
Mailing Address - Phone:651-480-4200
Mailing Address - Fax:651-480-4306
Practice Address - Street 1:1285 NININGER RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1086
Practice Address - Country:US
Practice Address - Phone:651-480-4200
Practice Address - Fax:651-480-4306
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR079952-8363LF0000X
WI90758-030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-02574OtherMEDICA
MN123406OtherUCARE MINNESOTA
MN21934OtherAMERICA'S PPO
MN18G97NEOtherBLUE CROSS
MNNA9141020807OtherPREFERRED ONE
MNHP28178OtherHEALTH PARTNERS
MN18G97NEOtherBLUE CROSS