Provider Demographics
NPI:1093019895
Name:GASAWAY, JESSICA ANNE (NONE)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:GASAWAY
Suffix:
Gender:F
Credentials:NONE
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Other - First Name:
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Mailing Address - Street 1:690 E PLUMB LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-3563
Mailing Address - Country:US
Mailing Address - Phone:775-322-4650
Mailing Address - Fax:775-322-3137
Practice Address - Street 1:690 E PLUMB LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3563
Practice Address - Country:US
Practice Address - Phone:775-322-4650
Practice Address - Fax:775-322-3137
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner