Basic Information
| Provider Information | |||||||||
| NPI: | 1700056389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIELANDER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | MATTHEW | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9887 E BROOKSIDE AVE | ||||||||
| Address2: | |||||||||
| City: | GALVESTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 469328658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746990954 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 HICKORY RD | ||||||||
| Address2: | SUITE 240 | ||||||||
| City: | PLYMOUTH MEETING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194621047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178427435 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 03/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 27052295A | IN | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.