Individual
MICHELE K NELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14410 SE PETROVITSKY RD STE 104, RENTON, WA 98058-8900
(256) 903-4054
(425) 690-9405
Mailing address
3600 LIND AVE SW, STE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00035357
WA
207VX0000X
Obstetrics Physician
MD00035357
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1042822
—
WA
01
—
G8891361
MEDICARE W VALLEY MEDICAL GROUP - RENTON
WA
Enumeration date
07/28/2006
Last updated
03/31/2020
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