Provider Demographics
NPI:1689465619
Name:NELSON, JENISE (LPN)
Entity type:Individual
Prefix:
First Name:JENISE
Middle Name:
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:JENISE
Other - Middle Name:R
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:279 CORBIN CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-7452
Mailing Address - Country:US
Mailing Address - Phone:732-852-0888
Mailing Address - Fax:
Practice Address - Street 1:111 STATE ROUTE 35
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1512
Practice Address - Country:US
Practice Address - Phone:732-727-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP07356300164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse