Basic Information
Provider Information
NPI: 1144610700
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NELSON
FirstName: LINDSEY
MiddleName: N
NamePrefix:  
NameSuffix:  
Credential: APRN,CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 6001
Address2:  
City: FARGO
State: ND
PostalCode: 581086001
CountryCode: US
TelephoneNumber: 7013648000
FaxNumber:  
Practice Location
Address1: 3000 32ND AVE S
Address2:  
City: FARGO
State: ND
PostalCode: 581036132
CountryCode: US
TelephoneNumber: 7013648000
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/03/2015
LastUpdateDate: 12/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XR31694NDY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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