Provider Demographics
NPI:1801915178
Name:NELSON, JANICE H (RN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:H
Last Name:NELSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LAVINIA
Mailing Address - State:TN
Mailing Address - Zip Code:38348-3046
Mailing Address - Country:US
Mailing Address - Phone:731-423-3020
Mailing Address - Fax:
Practice Address - Street 1:804 N PARKWAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3058
Practice Address - Country:US
Practice Address - Phone:731-423-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000116072163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4448133Medicaid
TN626000729OtherEMPLOYERS TAX ID NUMBER
TN4448133Medicaid
TNP00276040Medicare PIN