Provider Demographics
NPI:1710485438
Name:DEL VALLE, JESSICA MARISOL
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARISOL
Last Name:DEL VALLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 LAYTON DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-6438
Mailing Address - Country:US
Mailing Address - Phone:973-986-3230
Mailing Address - Fax:
Practice Address - Street 1:25 E WILLOW ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1416
Practice Address - Country:US
Practice Address - Phone:973-379-5055
Practice Address - Fax:973-379-5324
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00761600363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily