Individual
JESSIE G NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
640 JACKSON STREET, MC11102F, ST PAUL, MN 55101-2502
(651) 254-3456
(651) 254-5216
Mailing address
8100 34TH AVE S, MC21110Q, BLOOMINGTON, MN 55425-1672
(952) 883-7172
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
46265
MN
207P00000X
Emergency Medicine Physician
48877
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
250455300
—
MN
Enumeration date
03/07/2006
Last updated
05/13/2019
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