Provider Demographics
NPI:1073248332
Name:DALEY, JESSIKA AN
Entity Type:Individual
Prefix:
First Name:JESSIKA
Middle Name:AN
Last Name:DALEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSIKA
Other - Middle Name:AN
Other - Last Name:GRIFFITHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA
Mailing Address - Street 1:203 S DAISY ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4709
Mailing Address - Country:US
Mailing Address - Phone:208-756-5711
Mailing Address - Fax:
Practice Address - Street 1:203 S DAISY ST
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4709
Practice Address - Country:US
Practice Address - Phone:208-339-5248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant