Provider Demographics
NPI:1699251397
Name:NELSON, JENA MARIE
Entity type:Individual
Prefix:MRS
First Name:JENA
Middle Name:MARIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENA
Other - Middle Name:MARIE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:NE
Mailing Address - Zip Code:68730-3307
Mailing Address - Country:US
Mailing Address - Phone:402-388-2343
Mailing Address - Fax:
Practice Address - Street 1:203 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:NE
Practice Address - Zip Code:68730-3307
Practice Address - Country:US
Practice Address - Phone:402-388-2343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2019-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily