Provider Demographics
NPI:1598758229
Name:GEORGE, JESSICA ELYSE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELYSE
Last Name:GEORGE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:ELYSE
Other - Last Name:HAAS-SYLVESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:4774 KIDRON RD
Mailing Address - Street 2:PO BOX 247
Mailing Address - City:KIDRON
Mailing Address - State:OH
Mailing Address - Zip Code:44636
Mailing Address - Country:US
Mailing Address - Phone:330-857-0177
Mailing Address - Fax:
Practice Address - Street 1:4774 KIDRON RD
Practice Address - Street 2:
Practice Address - City:KIDRON
Practice Address - State:OH
Practice Address - Zip Code:44636
Practice Address - Country:US
Practice Address - Phone:330-857-0177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH045197367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2164394Medicaid