Individual
JILLIAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5818 COLUMBIA AVE, HAMMOND, IN 46320-2607
(219) 237-5160
Mailing address
PO BOX 746721, ATLANTA, GA 30374-6721
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71006567A
APN LICENSE NUMBER
IN
Enumeration date
10/03/2016
Last updated
06/20/2022
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