Provider Demographics
NPI:1407451636
Name:LOY, JESSICA JOANN (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JOANN
Last Name:LOY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 CORNELL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-6346
Mailing Address - Country:US
Mailing Address - Phone:607-341-5784
Mailing Address - Fax:
Practice Address - Street 1:2109 CORNELL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-6346
Practice Address - Country:US
Practice Address - Phone:607-341-5784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY336224164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse