Provider Demographics
NPI:1407567928
Name:PIND, JESSICA CAROL (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CAROL
Last Name:PIND
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 1:1130 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5007
Mailing Address - Country:US
Mailing Address - Phone:618-351-1031
Mailing Address - Fax:618-351-1107
Practice Address - Street 1:1130 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5007
Practice Address - Country:US
Practice Address - Phone:618-351-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04308815164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse