Provider Demographics
NPI:1497330591
Name:MOSHER, JESSICA LORRAINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LORRAINE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 HENRY ST APT 6
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-3268
Mailing Address - Country:US
Mailing Address - Phone:530-840-4894
Mailing Address - Fax:
Practice Address - Street 1:1026 HENRY ST APT 6
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-3268
Practice Address - Country:US
Practice Address - Phone:530-840-4894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104330374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula