Provider Demographics
NPI:1851833966
Name:NELSON, JASON (CRM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5257 NE MARTIN LUTHER KING JR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3282
Mailing Address - Country:US
Mailing Address - Phone:503-676-3710
Mailing Address - Fax:
Practice Address - Street 1:5257 NE MARTIN LUTHER KING JR
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3282
Practice Address - Country:US
Practice Address - Phone:503-676-3710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-CRM-007175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16-CRM-007OtherACCBO