Provider Demographics
NPI:1639423833
Name:MCDOWELL, JESSIE R (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:R
Last Name:MCDOWELL
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 1:7003 STATE STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-8044
Mailing Address - Country:US
Mailing Address - Phone:315-567-2922
Mailing Address - Fax:
Practice Address - Street 1:7003 STATE STREET RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-8044
Practice Address - Country:US
Practice Address - Phone:315-567-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282804164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse