Provider Demographics
NPI:1770968521
Name:NELSON, PATRICIA KAY (APNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:KAY
Last Name:NELSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:KAY
Other - Last Name:O'CONNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:788 N JEFFERSON ST
Mailing Address - Street 2:SUITE 300/ATTN. KAAREN BUTZEN
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3718
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-225-2929
Practice Address - Street 1:13133 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE G-18
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2419
Practice Address - Country:US
Practice Address - Phone:262-243-5000
Practice Address - Fax:262-243-5317
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6485363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1770968521Medicaid
WI1770968521Medicaid