Provider Demographics
NPI:1598883712
Name:KNEE, JESSICA ELAINE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ELAINE
Last Name:KNEE
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 1:1176 MOUNT PLEASANT ST NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-5973
Mailing Address - Country:US
Mailing Address - Phone:330-417-9582
Mailing Address - Fax:
Practice Address - Street 1:1176 MOUNT PLEASANT ST NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-5973
Practice Address - Country:US
Practice Address - Phone:330-417-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416728Medicaid