Provider Demographics
NPI:1073361788
Name:NELSEN, JILLIAN MAE (RN, BSN)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:MAE
Last Name:NELSEN
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 LAKEVIEW ACRES DR # 14A
Mailing Address - Street 2:
Mailing Address - City:JOHNSON LAKE
Mailing Address - State:NE
Mailing Address - Zip Code:68937-2224
Mailing Address - Country:US
Mailing Address - Phone:308-746-3132
Mailing Address - Fax:
Practice Address - Street 1:39 LAKEVIEW ACRES DR # 14A
Practice Address - Street 2:
Practice Address - City:JOHNSON LAKE
Practice Address - State:NE
Practice Address - Zip Code:68937-2224
Practice Address - Country:US
Practice Address - Phone:308-746-3132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59726163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care