Provider Demographics
NPI:1801507074
Name:NILSON, JESSICA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NILSON
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-6864
Mailing Address - Country:US
Mailing Address - Phone:605-380-0367
Mailing Address - Fax:
Practice Address - Street 1:807 TAYLOR DR
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-6864
Practice Address - Country:US
Practice Address - Phone:605-380-0367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDA-3642626171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach