Individual
DANIEL NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12800 N LAKE SHORE DR, MEQUON, WI 53097-2418
(262) 243-2129
Mailing address
1740 W GRAND AVE APT 203, PORT WASHINGTON, WI 53074-2094
(612) 695-5925
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
1024526
MN
146N00000X
Basic Emergency Medical Technician
70120592
WI
2255A2300X
Athletic Trainer
Primary
3221-39
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/27/2023
Last updated
05/26/2026
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