Provider Demographics
NPI:1952946402
Name:NELSON, JENNIFER MARIE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:NELSON
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:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0071
Mailing Address - Country:US
Mailing Address - Phone:541-999-4880
Mailing Address - Fax:
Practice Address - Street 1:15555 OLD STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:OR
Practice Address - Zip Code:97490-9713
Practice Address - Country:US
Practice Address - Phone:541-999-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula