Provider Demographics
NPI:1720418619
Name:TESSON, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:TESSON
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 1:4004 STATE ROUTE 19
Mailing Address - Street 2:
Mailing Address - City:SCIO
Mailing Address - State:NY
Mailing Address - Zip Code:14880-9681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4004 STATE ROUTE 19
Practice Address - Street 2:
Practice Address - City:SCIO
Practice Address - State:NY
Practice Address - Zip Code:14880-9681
Practice Address - Country:US
Practice Address - Phone:585-596-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3155161164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse