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General NPI Number Information
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NPI Number | 1891244828
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Entity Type | Individual
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Provider Name | JILLIAN NELSON
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Gender | Female
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 5818 COLUMBIA AVE
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City | HAMMOND
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State | IN
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Zip | 46320-2607
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Country | US
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Telephone | 219-237-5160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746721
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City | ATLANTA
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State | GA
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Zip | 30374-6721
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Country | US
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Telephone |
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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 | 71006567A
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License Number State | IN
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