Basic Information
| Provider Information | |||||||||
| NPI: | 1134489297 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | JAMMIE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 ST. PAUL AVE #100 | ||||||||
| Address2: | TELECARE CORPORATION | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134826400 | ||||||||
| FaxNumber: | 2134826408 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 ST PAUL AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900172038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134826400 | ||||||||
| FaxNumber: | 2134826408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2012 | ||||||||
| LastUpdateDate: | 05/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN196856 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.