Provider Demographics
NPI:1174953202
Name:NELSON, JASON LYNN (RN)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LYNN
Last Name:NELSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 FORBES ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:IA
Mailing Address - Zip Code:51638-3024
Mailing Address - Country:US
Mailing Address - Phone:712-303-1865
Mailing Address - Fax:
Practice Address - Street 1:1800 N 16TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1101
Practice Address - Country:US
Practice Address - Phone:712-542-2388
Practice Address - Fax:712-542-2984
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA128114163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health