Active NPI
Jennifer M Nelson, SA-C
- Surgical Assistant
- Fort Wayne, IN
National Provider Identifier
1962686667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 07-321
- Practice address
- 1824 Forest TRL
Fort Wayne, IN 46845-9094 - Phone
- (260) 450-2870
- Fax
- (260) 637-3698
- NPI assigned
- Dec 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 07-321 | IN | Primary |
Addresses
Primary practice location
1824 Forest TRL
Fort Wayne, IN 46845-9094
Mailing address
1824 Forest TRL
Fort Wayne, IN 46845-9094
Phone (260) 450-2870
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07-321 | IN | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1197936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253145600000",
"number": "1962686667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1824 FOREST TRL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468459094",
"telephone_number": "260-450-2870",
"fax_number": "260-637-3698"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1824 FOREST TRL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468459094",
"telephone_number": "260-450-2870",
"fax_number": "260-637-3698"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JENNIFER",
"middle_name": "M",
"credential": "SA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-12-18",
"last_updated": "2009-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "IN",
"license": "07-321",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.