Provider Demographics
NPI:1093241606
Name:FISK, JESSICA (ETC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FISK
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 CAREY AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-1936
Mailing Address - Country:US
Mailing Address - Phone:330-212-7373
Mailing Address - Fax:
Practice Address - Street 1:1206 CAREY AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-1936
Practice Address - Country:US
Practice Address - Phone:330-212-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202354Medicaid