Individual
JACK NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9 HANOVER ST, SUITE 2, LEBANON, NH 03766-1312
(603) 448-0126
Mailing address
85 MECHANIC ST, SUITE 360, LEBANON, NH 03766-1537
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
04/10/2007
Last updated
07/08/2007
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