Provider Demographics
NPI:1205835337
Name:NELSON, JEAN AUDREY (FNP-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:AUDREY
Last Name:NELSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 E MONTEREY WAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6900
Mailing Address - Country:US
Mailing Address - Phone:480-949-7377
Mailing Address - Fax:480-949-8339
Practice Address - Street 1:7514 E MONTEREY WAY
Practice Address - Street 2:SUITE 1
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6900
Practice Address - Country:US
Practice Address - Phone:480-949-7377
Practice Address - Fax:480-949-8339
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 1768207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ873415Medicaid
AZ873415Medicaid
80786Medicare ID - Type UnspecifiedWCHMS