Provider Demographics
NPI:1619122777
Name:BLUM, JESSICA E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:E
Last Name:BLUM
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 1ST AVE
Mailing Address - Street 2:GBH-C124
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6401
Mailing Address - Country:US
Mailing Address - Phone:212-263-6600
Mailing Address - Fax:
Practice Address - Street 1:545 1ST AVE
Practice Address - Street 2:GBH-C124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6401
Practice Address - Country:US
Practice Address - Phone:212-263-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430411-1363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care