Provider Demographics
NPI:1629523972
Name:SIERRA, JESSICA ANDREA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANDREA
Last Name:SIERRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 YORK AVE
Mailing Address - Street 2:APT 8D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7169
Mailing Address - Country:US
Mailing Address - Phone:718-450-2259
Mailing Address - Fax:
Practice Address - Street 1:369 E 149TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-3906
Practice Address - Country:US
Practice Address - Phone:718-450-2259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY706106163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse