Provider Demographics
NPI:1225475171
Name:ADDAI, JESSICA (RN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:
Last Name:ADDAI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-1328
Mailing Address - Country:US
Mailing Address - Phone:419-610-6582
Mailing Address - Fax:
Practice Address - Street 1:508 FULTON ST
Practice Address - Street 2:B10017
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3875
Practice Address - Country:US
Practice Address - Phone:919-286-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC252746163W00000X
OHRN.358466163W00000X
FLRN9307669163W00000X
PARN637068163W00000X
VA0001240556163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse