Provider Demographics
NPI:1588211239
Name:AYISSI ESSONO, JEAN SYLVESTRE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JEAN SYLVESTRE
Middle Name:
Last Name:AYISSI ESSONO
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FORBES AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3412
Mailing Address - Country:US
Mailing Address - Phone:417-631-2562
Mailing Address - Fax:
Practice Address - Street 1:3600 FORBES AVE STE 304
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3412
Practice Address - Country:US
Practice Address - Phone:417-631-2562
Practice Address - Fax:412-864-1931
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP019711363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care