Provider Demographics
NPI:1306186184
Name:MANDRELL, JESSICA LYNN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:MANDRELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BLUVSTEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, AG-ACNP
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-5502
Mailing Address - Fax:614-293-7221
Practice Address - Street 1:452 W 10TH AVE FL 1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-5502
Practice Address - Fax:614-293-7221
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.14370363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0113556Medicaid