Provider Demographics
NPI:1194458695
Name:NAVEDO, JESENIA MARIE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JESENIA
Middle Name:MARIE
Last Name:NAVEDO
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 BRIGHAM ST # 1
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2207
Mailing Address - Country:US
Mailing Address - Phone:177-432-8428
Mailing Address - Fax:
Practice Address - Street 1:45 BRIGHAM ST # 1
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2207
Practice Address - Country:US
Practice Address - Phone:177-432-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-03
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2270253163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty