Provider Demographics
NPI:1689180838
Name:LEGG, JESSICA DAWN (RN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:DAWN
Last Name:LEGG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:DAWN
Other - Last Name:RIDDLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 KOKANEE DR.
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-3727
Mailing Address - Country:US
Mailing Address - Phone:530-353-3391
Mailing Address - Fax:
Practice Address - Street 1:120 KOKANEE DRIVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966
Practice Address - Country:US
Practice Address - Phone:530-353-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA841181163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse