Provider Demographics
NPI:1164196713
Name:JOHN, JESSICA JANAY
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JANAY
Last Name:JOHN
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 1:5050 TAMARUS ST APT 151
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2030
Mailing Address - Country:US
Mailing Address - Phone:951-250-2879
Mailing Address - Fax:
Practice Address - Street 1:5050 TAMARUS ST APT 151
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2030
Practice Address - Country:US
Practice Address - Phone:951-250-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant