Provider Demographics
NPI:1417748864
Name:NELSON, AMBER NICHOL
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICHOL
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N BENTON DR STE 105
Mailing Address - Street 2:
Mailing Address - City:SAUK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56379-1597
Mailing Address - Country:US
Mailing Address - Phone:320-252-2225
Mailing Address - Fax:320-252-2159
Practice Address - Street 1:225 N BENTON DR STE 105
Practice Address - Street 2:
Practice Address - City:SAUK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56379-1597
Practice Address - Country:US
Practice Address - Phone:320-252-2225
Practice Address - Fax:320-252-2159
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist