Healthcare Provider Details

I. General information

NPI: 1407802515
Provider Name (Legal Business Name): JENNIFER J. NELSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LEVESQUE DR SUITE 2
ELIOT ME
03903-2079
US

IV. Provider business mailing address

789 CENTRAL AVE
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 207-451-9600
  • Fax: 207-451-9603
Mailing address:
  • Phone: 603-740-4478
  • Fax: 603-740-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0355392303
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: