Provider Demographics
NPI:1326385857
Name:DRINKWINE, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DRINKWINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996-3474
Mailing Address - Country:US
Mailing Address - Phone:518-586-6340
Mailing Address - Fax:
Practice Address - Street 1:1850 ROUTE 22
Practice Address - Street 2:
Practice Address - City:KEESEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12944
Practice Address - Country:US
Practice Address - Phone:518-578-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist