Provider Demographics
NPI:1346208881
Name:VAN RYE, JESSICA HANLON (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HANLON
Last Name:VAN RYE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HANLON
Other - Last Name:VAN RYE-PLASSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:88 NORWICH NEW LONDON TPKE # PC
Mailing Address - Street 2:SUITE 1
Mailing Address - City:UNCASVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06382-2518
Mailing Address - Country:US
Mailing Address - Phone:860-848-9157
Mailing Address - Fax:860-848-3471
Practice Address - Street 1:400 BAYONET ST STE 206
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2633
Practice Address - Country:US
Practice Address - Phone:860-895-8195
Practice Address - Fax:860-892-8223
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002779363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT400002779CT01OtherANTHEM BLUE CROSS
CT004229276Medicaid
CTD400153410OtherDEA
CT400002779CT01OtherANTHEM BLUE CROSS
CTD400153410OtherDEA
P79750Medicare UPIN