Provider Demographics
NPI:1033759162
Name:REHO, JESSICA MARY (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARY
Last Name:REHO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STRATHALLAN PARK APT 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1534
Mailing Address - Country:US
Mailing Address - Phone:585-613-5475
Mailing Address - Fax:
Practice Address - Street 1:25 STRATHALLAN PARK APT 5
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1534
Practice Address - Country:US
Practice Address - Phone:585-613-5475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY682119-1163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care