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Individual

JACQUELINE J NELSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
8901 W LINCOLN AVE, WEST ALLIS, WI 53227-2409
(414) 328-7200
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3328
WI
367500000X
Certified Registered Nurse Anesthetist
D100610
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0469619
IA
01
39204
WELLMARK BCBS
IA
05
44369200
WI
Enumeration date
11/08/2005
Last updated
03/27/2024
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