Provider Demographics
NPI:1336731439
Name:NIELSEN, JADE ALEXIS
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ALEXIS
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 FOREST PARK DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-9411
Mailing Address - Country:US
Mailing Address - Phone:918-530-1723
Mailing Address - Fax:
Practice Address - Street 1:1809 FOREST PARK DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-9411
Practice Address - Country:US
Practice Address - Phone:918-530-1723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator