Individual
MISCHELLE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Mailing address
1221 E STATE ST, ROCKFORD, IL 61104-2231
(815) 972-1000
(815) 972-1086
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
125077199
IL
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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