Provider Demographics
NPI:1093433294
Name:SERAFIN, JESSICA MARIE
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIE
Last Name:SERAFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 FERNDALE LN
Mailing Address - Street 2:
Mailing Address - City:MINOA
Mailing Address - State:NY
Mailing Address - Zip Code:13116-1133
Mailing Address - Country:US
Mailing Address - Phone:315-857-3711
Mailing Address - Fax:
Practice Address - Street 1:405 FERNDALE LN
Practice Address - Street 2:
Practice Address - City:MINOA
Practice Address - State:NY
Practice Address - Zip Code:13116-1133
Practice Address - Country:US
Practice Address - Phone:315-857-3711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648220163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse