Basic Information
| Provider Information | |||||||||
| NPI: | 1700903556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | JENNIFER | ||||||||
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| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 ASTBURY LN | ||||||||
| Address2: | |||||||||
| City: | SEDGWICK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 046763423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177344741 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7 WALL ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WINDHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030871663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038934515 | ||||||||
| FaxNumber: | 8664201055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225100000X | 10646 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.