Healthcare Provider Details

I. General information

NPI: 1205835337
Provider Name (Legal Business Name): JEAN AUDREY NELSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7514 E MONTEREY WAY SUITE 1
SCOTTSDALE AZ
85251-6900
US

IV. Provider business mailing address

7514 E MONTEREY WAY SUITE 1
SCOTTSDALE AZ
85251-6900
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-7377
  • Fax: 480-949-8339
Mailing address:
  • Phone: 480-949-7377
  • Fax: 480-949-8339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberAP 1768
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: