Provider Demographics
NPI:1396940144
Name:NELSON, KATHERINE E (ND NATUROPATHIC PHYS)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:E
Last Name:NELSON
Suffix:
Gender:F
Credentials:ND NATUROPATHIC PHYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-0643
Mailing Address - Country:US
Mailing Address - Phone:906-228-2298
Mailing Address - Fax:906-228-2298
Practice Address - Street 1:327 ALGER
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-228-2298
Practice Address - Fax:906-228-2298
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0990000120175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0990000120OtherPRACTICE LICENSE
21152904OtherPASSPORT