Provider Demographics
NPI:1053831958
Name:POLSELLI, JESSICA ANGELA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANGELA
Last Name:POLSELLI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 GLEN AVE
Mailing Address - Street 2:
Mailing Address - City:UPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01568-1716
Mailing Address - Country:US
Mailing Address - Phone:508-922-8318
Mailing Address - Fax:
Practice Address - Street 1:135 GLEN AVE
Practice Address - Street 2:
Practice Address - City:UPTON
Practice Address - State:MA
Practice Address - Zip Code:01568
Practice Address - Country:US
Practice Address - Phone:508-922-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN69775164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse