Provider Demographics
NPI:1609141423
Name:NOCILLY, JESSICA LYNNE
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LYNNE
Last Name:NOCILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 UNION AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1746
Mailing Address - Country:US
Mailing Address - Phone:315-748-3290
Mailing Address - Fax:
Practice Address - Street 1:79 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2449
Practice Address - Country:US
Practice Address - Phone:315-748-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY761050163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse