Healthcare Provider Details

I. General information

NPI: 1881180883
Provider Name (Legal Business Name): JAMIE DANIELLE NELSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE DANIELLE VANDER VORSTE

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MCDOUGALL DR UNIT 1
LINCOLN ND
58504
US

IV. Provider business mailing address

105 MCDOUGALL DR UNIT 1
LINCOLN ND
58504
US

V. Phone/Fax

Practice location:
  • Phone: 701-333-7979
  • Fax: 701-595-7109
Mailing address:
  • Phone: 701-333-7979
  • Fax: 701-595-7109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH6031
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: