Provider Demographics
NPI:1992450910
Name:NELSON, JENNA CHARLOTTE (DPT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:CHARLOTTE
Last Name:NELSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:CHARLOTTE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNA DEGERLUND
Mailing Address - Street 1:PO BOX 82523
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2523
Mailing Address - Country:US
Mailing Address - Phone:907-978-0037
Mailing Address - Fax:
Practice Address - Street 1:122 1ST AVE STE 600
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4871
Practice Address - Country:US
Practice Address - Phone:907-452-8251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist