Individual
JENNIFER NIELSEN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD/MPH
Contact information
Practice address
2401 S 31ST ST # MS 01663, TEMPLE, TX 76508-1032
(971) 409-2258
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
S8303
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2018
Last updated
08/08/2022
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