Provider Demographics
NPI:1508191966
Name:RUMSEY, JESSICA DAWN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:DAWN
Last Name:RUMSEY
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 1:4778 MACDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865-9753
Mailing Address - Country:US
Mailing Address - Phone:607-481-4535
Mailing Address - Fax:
Practice Address - Street 1:4778 MACDOWELL RD
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865-9753
Practice Address - Country:US
Practice Address - Phone:607-481-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298582-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY298582-1OtherINDEPENDENT MEDICARE PROVIDER