Provider Demographics
NPI:1669893269
Name:NELSEN, ROBERT (RN)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:NELSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:NELSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:409 S WEBSTER AVE APT 215
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3947
Mailing Address - Country:US
Mailing Address - Phone:715-252-4263
Mailing Address - Fax:
Practice Address - Street 1:409 S WEBSTER AVE APT 215
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3947
Practice Address - Country:US
Practice Address - Phone:715-252-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120337-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse