Provider Demographics
NPI:1386187946
Name:NORTON, JESSICA (ATC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:NORTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOYT ST
Mailing Address - Street 2:P.O. BOX 10
Mailing Address - City:PERU
Mailing Address - State:NE
Mailing Address - Zip Code:68421-3073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 HOYT ST
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:NE
Practice Address - Zip Code:68421-3073
Practice Address - Country:US
Practice Address - Phone:402-872-2390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer