Provider Demographics
NPI:1407489115
Name:JESKE, KENNA (RN)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:
Last Name:JESKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4510
Mailing Address - Country:US
Mailing Address - Phone:916-643-7155
Mailing Address - Fax:916-643-7155
Practice Address - Street 1:1435 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4510
Practice Address - Country:US
Practice Address - Phone:916-643-7155
Practice Address - Fax:916-643-7155
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA675850163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management