Individual
THEA MARIE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1013 111TH AVE NE, BLAINE, MN 55434-4519
(763) 245-3643
(763) 862-7438
Mailing address
9465 IRVING AVE N, BROOKLYN PARK, MN 55444-2932
(763) 657-0037
(763) 862-7438
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L-038481-0
MN
Other
Enumeration date
10/10/2007
Last updated
10/10/2007
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