Provider Demographics
NPI:1104177609
Name:KLEINHESSELINK, NELVA JEAN (MA)
Entity Type:Individual
Prefix:MRS
First Name:NELVA
Middle Name:JEAN
Last Name:KLEINHESSELINK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:1024 LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:SUMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98295-9108
Mailing Address - Country:US
Mailing Address - Phone:360-988-9423
Mailing Address - Fax:360-988-0505
Practice Address - Street 1:1024 LAWSON ST
Practice Address - Street 2:
Practice Address - City:SUMAS
Practice Address - State:WA
Practice Address - Zip Code:98295-9108
Practice Address - Country:US
Practice Address - Phone:360-988-9423
Practice Address - Fax:360-988-0505
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA303067C174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist