Provider Demographics
NPI:1700056389
Name:NIELANDER, JASON MATTHEW (LPN)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:NIELANDER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9887 E BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:IN
Mailing Address - Zip Code:46932-8658
Mailing Address - Country:US
Mailing Address - Phone:574-699-0954
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:317-842-7435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27052295A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse