Provider Demographics
NPI:1497437081
Name:POWERS, JESSICA (ESTHETICI AND MEDAID)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:POWERS
Suffix:
Gender:F
Credentials:ESTHETICI AND MEDAID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MALCOLM CT # NA
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68521-4630
Mailing Address - Country:US
Mailing Address - Phone:812-243-2674
Mailing Address - Fax:
Practice Address - Street 1:801 MALCOLM CT # NA
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68521-4630
Practice Address - Country:US
Practice Address - Phone:812-243-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2067202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine