Provider Demographics
NPI:1396968806
Name:NELSON, SHANA MARIE (CNP, RN)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:CNP, RN
Other - Prefix:
Other - First Name:SHNAA
Other - Middle Name:MARIE
Other - Last Name:SCHNORTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1912 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1695
Mailing Address - Country:US
Mailing Address - Phone:320-339-0605
Mailing Address - Fax:
Practice Address - Street 1:100 2ND ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-1977
Practice Address - Country:US
Practice Address - Phone:320-251-2600
Practice Address - Fax:320-252-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR161219-6163W00000X
MN7843363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse