Provider Demographics
NPI:1255305082
Name:NEILSON, P JO ANN (ARNP)
Entity Type:Individual
Prefix:
First Name:P
Middle Name:JO ANN
Last Name:NEILSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 EASTERN AVE.
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2709
Mailing Address - Country:US
Mailing Address - Phone:563-355-1853
Mailing Address - Fax:563-359-1512
Practice Address - Street 1:5350 EASTERN AVE.
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2709
Practice Address - Country:US
Practice Address - Phone:563-355-1853
Practice Address - Fax:563-359-1512
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF054694363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS51792Medicare UPIN
IA0092429Medicare ID - Type Unspecified