Provider Demographics
NPI:1912385287
Name:NELSON, JENNIFER MARIE (RN, BSN, TM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN, BSN, TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SAWMILL LN
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-9656
Mailing Address - Country:US
Mailing Address - Phone:724-968-2264
Mailing Address - Fax:
Practice Address - Street 1:185 BRADFORD RD
Practice Address - Street 2:
Practice Address - City:BRADFORDWOODS
Practice Address - State:PA
Practice Address - Zip Code:15015-1247
Practice Address - Country:US
Practice Address - Phone:724-968-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-07
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN529078L163WM0102X
176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn