Provider Demographics
NPI:1033414867
Name:JESKE, STEVEN PAUL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:JESKE
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 HIGHLAND AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3022
Mailing Address - Country:US
Mailing Address - Phone:203-518-5232
Mailing Address - Fax:888-372-6480
Practice Address - Street 1:276 HIGHLAND AVE STE A2
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708
Practice Address - Country:US
Practice Address - Phone:203-819-7220
Practice Address - Fax:203-819-7270
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004592363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247872Medicaid