Provider Demographics
NPI:1861205890
Name:NELSON, MARILEE SUSAN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARILEE
Middle Name:SUSAN
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARILEE
Other - Middle Name:SUSAN
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:4801 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2015
Mailing Address - Country:US
Mailing Address - Phone:320-252-1670
Mailing Address - Fax:
Practice Address - Street 1:7949 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55319-4611
Practice Address - Country:US
Practice Address - Phone:763-370-3050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1915945163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse