Provider Demographics
NPI:1669572988
Name:NELSON, MARGIE RUTH (CFNP)
Entity type:Individual
Prefix:
First Name:MARGIE
Middle Name:RUTH
Last Name:NELSON
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 4TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:56334-1820
Mailing Address - Country:US
Mailing Address - Phone:320-634-5157
Mailing Address - Fax:320-634-2244
Practice Address - Street 1:10 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MN
Practice Address - Zip Code:56334-1820
Practice Address - Country:US
Practice Address - Phone:320-634-5157
Practice Address - Fax:320-634-2244
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1104057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN088H6NEOtherBLUE CROSS PROVIDER #
MN122525100Medicaid
MN138019OtherUCARE PROVIDER #
MNP00293961OtherRAILROAD MEDICARE #
MN500003243Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER#
MN122525100Medicaid