Individual
MICHELLE R NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
146 E GENEVA SQ, LAKE GENEVA, WI 53147-9694
(262) 249-5000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1662023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41979800
—
WI
Enumeration date
11/08/2005
Last updated
10/07/2025
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