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General NPI Number Information
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NPI Number | 1346786019
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Entity Type | Individual
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Provider Name | JENNIFER NELSEN AGACNP
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Gender | Female
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 36650 ROAD 112
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City | VISALIA
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State | CA
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Zip | 93291-9517
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Country | US
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Telephone | 559-735-1319
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Fax |
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Provider Business Mailing Address
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Address Line | 2305 W ROBIN AVE
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City | VISALIA
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State | CA
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Zip | 93291-8069
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Country | US
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Telephone | 559-799-5598
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95005804
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License Number State | CA
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