Provider Demographics
NPI:1578193660
Name:STRONG, JESSICA ANN (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
Last Name:STRONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANN
Other - Last Name:BONNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 N CHAPPELL ST
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:NY
Mailing Address - Zip Code:13080-4513
Mailing Address - Country:US
Mailing Address - Phone:315-689-8520
Mailing Address - Fax:315-689-3024
Practice Address - Street 1:9 N CHAPPELL ST
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:NY
Practice Address - Zip Code:13080-4513
Practice Address - Country:US
Practice Address - Phone:315-689-8520
Practice Address - Fax:315-689-3024
Is Sole Proprietor?:No
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY694488163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool