Provider Demographics
NPI:1225261027
Name:JESKE, DON W (NP-C)
Entity Type:Individual
Prefix:MR
First Name:DON
Middle Name:W
Last Name:JESKE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 BEAR VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7741
Mailing Address - Country:US
Mailing Address - Phone:760-245-9999
Mailing Address - Fax:760-245-8855
Practice Address - Street 1:17330 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7741
Practice Address - Country:US
Practice Address - Phone:760-245-9999
Practice Address - Fax:760-245-8855
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13148363LF0000X
CA513743163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse