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General NPI Number Information
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NPI Number | 1164409587
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Entity Type | Individual
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Provider Name | JENNIFER L NELSON APRN
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 220 MAIN ST STE 1A
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City | OXFORD
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State | CT
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Zip | 06478-1065
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Country | US
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Telephone | 203-888-5527
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Fax | 203-888-3727
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Provider Business Mailing Address
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Address Line | 67 MAPLE AVE
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City | DERBY
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State | CT
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Zip | 06418-1328
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Country | US
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Telephone | 203-732-7325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 3304
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 3304
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 003304
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License Number State | CT
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