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General NPI Number Information
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NPI Number | 1649397498
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Entity Type | Individual
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Provider Name | JENNIFER MARGARET NELSON MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 10400 75TH ST PEDIATRICS
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City | KENOSHA
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State | WI
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Zip | 53142-7884
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Country | US
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Telephone | 262-948-6367
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Fax |
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Provider Business Mailing Address
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Address Line | 1184 MARK CT
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City | ANTIOCH
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State | IL
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Zip | 60002-9401
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Country | US
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Telephone | 847-274-7530
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 53245-20
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License Number State | WI
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