Provider Demographics
NPI:1174777981
Name:NELSON, KIMBERLY JANE YZERMANS
Entity type:Individual
Prefix:MS
First Name:KIMBERLY JANE
Middle Name:YZERMANS
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JANE
Other - Last Name:YZERMANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:521 BROADWAY AVENUE NORTH
Mailing Address - City:BRAHAM
Mailing Address - State:MN
Mailing Address - Zip Code:55006
Mailing Address - Country:US
Mailing Address - Phone:320-396-3333
Mailing Address - Fax:320-396-3363
Practice Address - Street 1:521 BROADWAY AVENUE NORTH
Practice Address - Street 2:FIRVE COUNTY MENTAL HEALTH CENTER - BRAHAM OFFICE
Practice Address - City:BRAHAM
Practice Address - State:MN
Practice Address - Zip Code:55006
Practice Address - Country:US
Practice Address - Phone:320-396-3333
Practice Address - Fax:320-396-3363
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator