Provider Demographics
NPI:1629374210
Name:NELSON, JAMIE LYNN (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:NELSON
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-471-1044
Mailing Address - Fax:315-474-4312
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-471-1044
Practice Address - Fax:315-474-4312
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2014-02-03
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Provider Licenses
StateLicense IDTaxonomies
NY014586-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant