Provider Demographics
NPI:1346436920
Name:JESSAMY, DENNIE ELIZABETH (RN)
Entity Type:Individual
Prefix:MISS
First Name:DENNIE
Middle Name:ELIZABETH
Last Name:JESSAMY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:39 JACKSON STREET
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553
Mailing Address - Country:US
Mailing Address - Phone:914-699-2150
Mailing Address - Fax:914-699-2150
Practice Address - Street 1:1148 5TH AVENUE
Practice Address - Street 2:APT 3C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-996-7926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5874671163W00000X
NY2343311164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02155677Medicaid