Provider Demographics
NPI:1376025627
Name:BIRD, JESSICA A (RN, BSN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:BIRD
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 PLANK RD APT 1
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-3312
Mailing Address - Country:US
Mailing Address - Phone:802-780-7640
Mailing Address - Fax:
Practice Address - Street 1:335 PLANK RD APT 1
Practice Address - Street 2:
Practice Address - City:POESTENKILL
Practice Address - State:NY
Practice Address - Zip Code:12140-3312
Practice Address - Country:US
Practice Address - Phone:802-780-7640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY688731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse