Shannon Carl Nelson, OTR

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

102239 Issued in MN

Practice address

Highway 1 Box 497
Red Lake, MN 56671

Phone

(218) 679-3316

NPI assigned

Jun 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pharmacy Dept. PHS Indian Hopsital

  • General Acute Care Hospital
  • Red Lake, MN
  • NPI 1972644318
  NPD (past)
• PHS Indian Hospital

  • General Acute Care Hospital
  • Red Lake, MN
  • NPI 1508809765
  NPD (past)
• Ponemah Clinic

  • Health Service Clinic/Center
  • Red Lake, MN
  • NPI 1760680300
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104029388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "566210299",
            "telephone_number": "218-679-3316",
            "fax_number": "218-679-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HIGHWAY 1 BOX 497",
            "city": "RED LAKE",
            "state": "MN",
            "postal_code": "56671",
            "telephone_number": "218-679-3316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "SHANNON",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "credential": "OTR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MN",
            "license": "102239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OCCUPATIONAL THERAPY LIC.",
            "identifier": "102239",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Ann Mathison, RN
• Casey Lee McDougall, PH.D., L.P.
• Mino-Miikanaang Bima'Adoo
• Hannah Faith Moses, PHARMD
• Jennifer A Naiser, D.O.
• Hoaibac Nguyen, PHARM.D.
• Amelia Olson, PHARMD
• Luke Joseph Peltier, PHARMD
• Pharmacy Dept. PHS Indian Hopsital
• PHS Indian Hospital

• General Acute Care Hospital in Red Lake, MN
• Providers in Red Lake, MN by specialty
• General Acute Care Hospital in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.