Provider Demographics
NPI:1225724669
Name:ALTAMIRANO, JESSICA LUCAS (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LUCAS
Last Name:ALTAMIRANO
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MARTLING RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7208
Mailing Address - Country:US
Mailing Address - Phone:256-585-5942
Mailing Address - Fax:
Practice Address - Street 1:408 MARTLING RD
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35951-7208
Practice Address - Country:US
Practice Address - Phone:256-585-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-180962163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse