Basic Information
| Provider Information | |||||||||
| NPI: | 1255305082 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEILSON | ||||||||
| FirstName: | P | ||||||||
| MiddleName: | JO ANN | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 EASTERN AVE. | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633551853 | ||||||||
| FaxNumber: | 5633591512 | ||||||||
| Practice Location | |||||||||
| Address1: | 5350 EASTERN AVE. | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528072709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633551853 | ||||||||
| FaxNumber: | 5633591512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2006 | ||||||||
| LastUpdateDate: | 01/31/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | F054694 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.