| Doctor Name: | MRS. CONNIE MICHELLE NELSON |
| NPI Number: | 1679560304 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | N25223 |
| Business Practice Address: | 1115 B St Plummer, ID - 83851 |
| Business Phone Number: | 2086861931 |
| Business Fax Number: | 2086861035 |
| Mailing Address: | 170 Larch Rd, ST MARIES |
| State: | ID |
| Postal Code: | 838617150 |
| Phone Number: | 2082452116 |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP2201X |
| License Number: | N25223 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Ambulatory Care |
| Taxonomy Definition: | |