MEDICARE: JESSICA NIELSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	M-11092	NM

General Provider Information

NPI Number	:	1326703893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA NIELSEN

Provider Business Mailing Address
First Line	:	430 MONROE ST NE APT B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1458
Country	:	US
Telephone Number	:	505-514-5110
Fax Number	:

Provider Business Practice Location Address
First Line	:	2900 LOUISIANA BLVD NE STE A2
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3550
Country	:	US
Telephone Number	:	505-209-2442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2021
Last Update Date	:	11/01/2021

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Directions to “ JESSICA NIELSEN ” Practice Location

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