Individual
GRANT V. NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6405 FRANCE AVE S, SUITE W440, EDINA, MN 55435-2163
(952) 927-7004
(952) 927-5146
Mailing address
3400 W 66TH ST, SUITE 350, EDINA, MN 55435-2111
(952) 832-0805
(952) 832-5597
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10136
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10136
LICENSE
MN
Enumeration date
06/17/2006
Last updated
11/25/2014
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