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General NPI Number Information
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NPI Number | 1639457161
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Entity Type | Individual
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Provider Name | JESSICA ANNE BAXTER NELSON RDHAP
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Gender | Female
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Dates
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Enumeration Date | 08/02/2011
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Last Update Date | 09/11/2011
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Provider Practice Location Address
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Address Line | 815 VISTA LN
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City | IONE
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State | CA
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Zip | 95640-5424
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Country | US
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Telephone | 916-717-5704
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Fax |
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Provider Business Mailing Address
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Address Line | 11310 PROSPECT DR SUITE 10 #211
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City | JACKSON
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State | CA
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Zip | 95642-9311
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Country | US
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Telephone | 916-717-5704
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | HAP 360
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License Number State | CA
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