MEDICARE: JANICE H. NELSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	RN0000116072	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801915178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE H. NELSON RN

Provider Business Mailing Address
First Line	:	3920 SPRING CREEK RD
Second Line	:
City	:	LAVINIA
State	:	TN
Zip	:	38348-3046
Country	:	US
Telephone Number	:	731-423-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 N PARKWAY
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-3058
Country	:	US
Telephone Number	:	731-423-3020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/15/2008

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