Provider Demographics
NPI:1225277924
Name:NELSON, JACQUELYNE C (DOM)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYNE
Middle Name:C
Last Name:NELSON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500 COMANCHE RD NE
Mailing Address - Street 2:BLDG A, SUITE 5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4546
Mailing Address - Country:US
Mailing Address - Phone:505-205-8941
Mailing Address - Fax:
Practice Address - Street 1:3500 COMANCHE RD NE
Practice Address - Street 2:BLDG A, SUITE 5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4546
Practice Address - Country:US
Practice Address - Phone:505-205-8941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist