Provider Demographics
NPI:1700846052
Name:NELSON, MICHELLE M (MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:RUSH CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55069-9063
Mailing Address - Country:US
Mailing Address - Phone:320-358-4784
Mailing Address - Fax:320-358-4665
Practice Address - Street 1:5366 386TH ST NE
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5833
Practice Address - Country:US
Practice Address - Phone:651-674-8353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR120703-5363LC1500X, 363LF0000X
MN3093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN560650100Medicaid
MN560650100Medicaid
S39636Medicare UPIN
MN500001002Medicare ID - Type Unspecified