Provider Demographics
NPI:1407802515
Name:NELSON, JENNIFER J (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:NELSON
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 1:789 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2526
Mailing Address - Country:US
Mailing Address - Phone:603-740-4478
Mailing Address - Fax:603-740-2244
Practice Address - Street 1:19 LEVESQUE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2079
Practice Address - Country:US
Practice Address - Phone:207-451-9600
Practice Address - Fax:207-451-9603
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0355392303363LF0000X
ME363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30011559Medicaid
ME282640099Medicaid
NHMN0364492OtherDEA
ME282640099Medicaid
NHNP1306Medicare ID - Type Unspecified