Provider Demographics
NPI:1184317976
Name:NEILSON, JESSICA (RMA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NEILSON
Suffix:
Gender:F
Credentials:RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 SUMMERNIGHT TER
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-2728
Mailing Address - Country:US
Mailing Address - Phone:608-799-5651
Mailing Address - Fax:
Practice Address - Street 1:1732 SUMMERNIGHT TER
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2728
Practice Address - Country:US
Practice Address - Phone:608-799-5651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO06D2281283246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management