MEDICARE: JADYN NELSON

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	152W00000X	Optometrist	804	ND

General Provider Information

NPI Number	:	1538853775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADYN NELSON

Provider Business Mailing Address
First Line	:	3700 RUEMMELE RD APT 105
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6436
Country	:	US
Telephone Number	:	182-309-3632
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 S 42ND ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-5712
Country	:	US
Telephone Number	:	701-775-3151
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	06/08/2023

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Directions to “ JADYN NELSON ” Practice Location

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