Healthcare Provider Details

I. General information

NPI: 1003094459
Provider Name (Legal Business Name): JENNIFER ANNE NELSON MS, RD, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

IV. Provider business mailing address

28441 LAS ARUBAS
LAGUNA NIGUEL CA
92677-7581
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-0224
  • Fax:
Mailing address:
  • Phone: 949-448-0775
  • Fax: 949-448-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: