=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497980999
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER J NELSON ARNP FAMILY HEALTH CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2009
-----------------------------------------------------
Last Update Date | 05/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 750 CENTRAL AVE SUITE L
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-617-3560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 750 CENTRAL AVE SUITE L
-----------------------------------------------------
City | DOVER
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03820-3434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-617-3560
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | MS. JENNIFER JAY NELSON
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 603-617-3560
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 0355392303
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------