Provider Demographics
NPI:1689187395
Name:HULETT, JESSICA LEE (RN)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEE
Last Name:HULETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CANISTEO
Mailing Address - State:NY
Mailing Address - Zip Code:14823-1233
Mailing Address - Country:US
Mailing Address - Phone:607-698-4225
Mailing Address - Fax:
Practice Address - Street 1:120 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:CANISTEO
Practice Address - State:NY
Practice Address - Zip Code:14823-1233
Practice Address - Country:US
Practice Address - Phone:607-698-4225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY626070163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY626070Medicaid