Provider Demographics
NPI:1740583251
Name:RIEMENSCHNEIDER, JESSICA (LPN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:RIEMENSCHNEIDER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 BROADWAY AVE
Mailing Address - Street 2:APT 11A
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4953
Mailing Address - Country:US
Mailing Address - Phone:631-767-0978
Mailing Address - Fax:
Practice Address - Street 1:865 BROADWAY AVE
Practice Address - Street 2:APT 11A
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4953
Practice Address - Country:US
Practice Address - Phone:631-767-0978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297055-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse