Individual
JENNIFER RUTH NICHELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
F.N.P.
Contact information
Practice address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Mailing address
619 E MASON ST, SUITE 4P57, SPRINGFIELD, IL 62701-1034
(217) 788-0706
(217) 525-2535
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
209.007151
IL
363LF0000X
Family Nurse Practitioner
Primary
209007151
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01775273
RAILROAD
IL
Enumeration date
08/01/2008
Last updated
05/20/2019
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