Provider Demographics
NPI:1225279383
Name:CRUZ, JESSENIA (LPN)
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S EAST AVE
Mailing Address - Street 2:APT 22
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5910
Mailing Address - Country:US
Mailing Address - Phone:800-950-6066
Mailing Address - Fax:
Practice Address - Street 1:766 S EAST AVE
Practice Address - Street 2:APT 22
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5910
Practice Address - Country:US
Practice Address - Phone:800-950-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06041000164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse