1205970787 NPI number — DR. JENNIFER LEE NESTELL/NIELSEN PHD MSW LICSW LSCSW

Table of content: DR. JENNIFER LEE NESTELL/NIELSEN PHD MSW LICSW LSCSW (NPI 1205970787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205970787 NPI number — DR. JENNIFER LEE NESTELL/NIELSEN PHD MSW LICSW LSCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESTELL/NIELSEN
Provider First Name:
JENNIFER
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD MSW LICSW LSCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEDGYESI
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSCSW, LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205970787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 613
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03570-0613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-242-5444
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERLIN
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03570-1884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-242-5444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2016030692 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 4297 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: LCS22907 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 2048 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)