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NPI Code Detail

MEDICARE: JAN NELSON NP-C, DBA, BALANCED WELLNESS MEDICAL CLINIC

MEDICARE: JAN NELSON NP-C, DBA, BALANCED WELLNESS MEDICAL CLINIC
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
1208D00000XGeneral Practice PhysicianAP60478189WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11538314257OTHERNPI

General Provider Information

NPI Number : 1427450535
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAN NELSON NP-C, DBA, BALANCED WELLNESS MEDICAL CLINIC
Provider Business Mailing Address
First Line : PO BOX 2808
Second Line :
City : HAYDEN
State : ID
Zip : 83835-2808
Country : US
Telephone Number : 208-651-3322
Fax Number :
Provider Business Practice Location Address
First Line : 1328 N STANFORD LN
Second Line : 101
City : LIBERTY LAKE
State : WA
Zip : 99019-5034
Country : US
Telephone Number : 509-891-7119
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JANICE NELSON
Credential :
Telephone Number : 208-651-3322
Provider Enumeration Date : 09/19/2014
Last Update Date : 09/19/2014

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Directions to “JAN NELSON NP-C, DBA, BALANCED WELLNESS MEDICAL CLINIC ” Practice Location

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