Individual
MAKENNA PEARL NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 326-3401
Mailing address
19624 BROOK PARK RD, PINE CITY, MN 55063-6030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
03/21/2025
Last updated
04/11/2025
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