Provider Demographics
NPI:1659787463
Name:DURHAM, JESSICA (CNM)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DURHAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E RIVERVIEW AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9805
Mailing Address - Country:US
Mailing Address - Phone:419-599-0055
Mailing Address - Fax:
Practice Address - Street 1:1600 E RIVERVIEW AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9805
Practice Address - Country:US
Practice Address - Phone:419-599-0055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15961-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife