Provider Demographics
NPI:1073890349
Name:MATTHEWS, JESSICA EVE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:EVE
Last Name:MATTHEWS
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 1:14 LAKE ST
Mailing Address - Street 2:APT 1
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1068
Mailing Address - Country:US
Mailing Address - Phone:585-500-9028
Mailing Address - Fax:
Practice Address - Street 1:14 LAKE ST
Practice Address - Street 2:APT 1
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-1068
Practice Address - Country:US
Practice Address - Phone:585-500-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2827171164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse