Individual
JEFFREY W NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PNP
Contact information
Practice address
525 PORTLAND AVE. SO., MC 952, MINNEAPOLIS, MN 55415
(612) 348-9840
(612) 596-7900
Mailing address
525 PORTLAND AVE. SO., MC 952, MINNEAPOLIS, MN 55415
(612) 348-9840
(612) 596-7900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9399
MN
363LP0200X
Pediatric Nurse Practitioner
91145
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12-01914
MEDICA
MN
01
—
33D77NE
BLUE CROSS BLUE SHIELD
MN
05
—
681325900
—
MN
Enumeration date
07/18/2006
Last updated
04/17/2013
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