Provider Demographics
NPI:1629840384
Name:WESCOTT, JESSICA M (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:WESCOTT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MCKINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5318
Mailing Address - Country:US
Mailing Address - Phone:609-209-3741
Mailing Address - Fax:856-309-9716
Practice Address - Street 1:212 E MADISON AVE
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:NJ
Practice Address - Zip Code:08049-1409
Practice Address - Country:US
Practice Address - Phone:856-602-4832
Practice Address - Fax:856-309-9716
Is Sole Proprietor?:No
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05432600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse