Provider Demographics
NPI:1851866859
Name:NELSON, JODI JANELL (MSN, WHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:JANELL
Last Name:NELSON
Suffix:
Gender:F
Credentials:MSN, WHNP-BC
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:JANELL
Other - Last Name:HIBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:63893 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8407
Mailing Address - Country:US
Mailing Address - Phone:520-780-8660
Mailing Address - Fax:
Practice Address - Street 1:51375 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9625
Practice Address - Country:US
Practice Address - Phone:541-536-8060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-06
Last Update Date:2018-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709233NP-PP363LW0102X
OR201393988RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse