Provider Demographics
NPI:1275585945
Name:NESIAMA, JO-ANN O (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:JO-ANN
Middle Name:O
Last Name:NESIAMA
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1935 MEDICAL DISTRICT DR
Mailing Address - Street 2:HOSPITAL BASED @ CMC DALLAS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-7701
Mailing Address - Country:US
Mailing Address - Phone:214-456-6371
Mailing Address - Fax:214-456-8312
Practice Address - Street 1:1935 MEDICAL DISTRICT DR
Practice Address - Street 2:HOSPITAL BASED @ CMC DALLAS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7701
Practice Address - Country:US
Practice Address - Phone:214-456-6371
Practice Address - Fax:214-456-8132
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI481492080P0204X
TXL3037207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34662400Medicaid
039906262YOtherHUMANA
0051S73601Medicare ID - Type Unspecified
WI34662400Medicaid