Provider Demographics
NPI:1083171540
Name:THOMAS, JESSICA ANN (IBCLC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:THOMAS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BENJOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:274 HOOKER AVE APT D1
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-3025
Mailing Address - Country:US
Mailing Address - Phone:585-259-7146
Mailing Address - Fax:
Practice Address - Street 1:274 HOOKER AVE APT D1
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-3025
Practice Address - Country:US
Practice Address - Phone:585-259-7146
Practice Address - Fax:888-566-2334
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY617847-1163W00000X
NYL-136972163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse