Provider Demographics
NPI:1629780291
Name:JESSUP, WENDY
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:JESSUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20026
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-6551
Mailing Address - Country:US
Mailing Address - Phone:910-364-6178
Mailing Address - Fax:
Practice Address - Street 1:408 TRESPAR LN APT 203
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-0379
Practice Address - Country:US
Practice Address - Phone:910-364-6178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker