Provider Demographics
NPI:1578114815
Name:MOFFETT, JESSICA JUNE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:JUNE
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 W SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85120-7456
Mailing Address - Country:US
Mailing Address - Phone:480-982-1110
Mailing Address - Fax:
Practice Address - Street 1:1575 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85120-7456
Practice Address - Country:US
Practice Address - Phone:480-982-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN155838163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse