Provider Demographics
NPI:1356426415
Name:NELSON, DEBORAH (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4811
Mailing Address - Country:US
Mailing Address - Phone:701-241-1360
Mailing Address - Fax:701-241-8559
Practice Address - Street 1:401 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4811
Practice Address - Country:US
Practice Address - Phone:701-241-1360
Practice Address - Fax:701-241-8559
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR21288363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15451OtherBCBS
MN167M9NEOtherBCBS
MN167M9NEOtherBCBS
ND711793Medicare ID - Type Unspecified