Provider Demographics
NPI:1033890900
Name:VALDEZ, JESSIE BRYAN (RN)
Entity Type:Individual
Prefix:MR
First Name:JESSIE
Middle Name:BRYAN
Last Name:VALDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 W HIAWATHA DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-5107
Mailing Address - Country:US
Mailing Address - Phone:619-944-9227
Mailing Address - Fax:
Practice Address - Street 1:39 W HIAWATHA DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-5107
Practice Address - Country:US
Practice Address - Phone:619-944-9227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.459319163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine