Provider Demographics
NPI:1740747963
Name:BROSSARD, JESSICA LEA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LEA
Last Name:BROSSARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:APPENHEIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:68 SEBRING DR
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4740
Mailing Address - Country:US
Mailing Address - Phone:716-844-1297
Mailing Address - Fax:
Practice Address - Street 1:68 SEBRING DR
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4740
Practice Address - Country:US
Practice Address - Phone:716-844-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY330738164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse