Provider Demographics
NPI:1548762693
Name:UCHYTIL, JESSIE LEA
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEA
Last Name:UCHYTIL
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 1:16583 N 1580TH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:IL
Mailing Address - Zip Code:62441-4212
Mailing Address - Country:US
Mailing Address - Phone:765-505-4753
Mailing Address - Fax:
Practice Address - Street 1:16583 N 1580TH ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:IL
Practice Address - Zip Code:62441-4212
Practice Address - Country:US
Practice Address - Phone:765-505-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula