1184044968 NPI number — DR. JOSEPH ANDREW NELSON M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184044968 NPI number — DR. JOSEPH ANDREW NELSON M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

NELSON

Provider First Name:

JOSEPH

Provider Middle Name:

ANDREW

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1184044968

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

8053 E BLOOMINGTON FWY STE 450

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BLOOMINGTON

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55420-1031

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-376-7708

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

8053 E BLOOMINGTON FWY STE 450

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BLOOMINGTON

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55420-1031

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-376-7708

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/21/2014

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  MD61320199 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: E-14883 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 2021-02781 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 036158248 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 38537 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 33959 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: MD475790 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 2021045545 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 72074 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: EMC0002092 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: MED-PHYS-LIC-111758 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 92908 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: Q9211 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 71884 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2021-02781 . This is a "NORTH CAROLINA LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: MD475790 . This is a "PENNSYLVANIA LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 036158248 . This is a "ILLINOIS LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
• Identifier: MD61320199 . This is a "WASHINGTON LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
• Identifier: Q9211 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 2021045545 . This is a "MISSOURI LICENSE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
• Identifier: EMC0002092 . This is a "MICHIGAN LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 72074 . This is a "CONNETICUT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: MED-PHYS-LIC-111758 . This is a "MONTANA LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 33959 . This is a "NEBRASKA LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 71884 . This is a "MINNESOTA LICENSE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 92908 . This is a "GEORGIA LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
• Identifier: 38537 . This is a "OKLAHOMA LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
• Identifier: E-14883 . This is a "ARKANSAS LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".