Provider Demographics
NPI:1790189934
Name:OCONNOR, JENESSA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:JENESSA
Middle Name:MARIE
Last Name:OCONNOR
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 1:199 SISSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:NY
Mailing Address - Zip Code:13849-2252
Mailing Address - Country:US
Mailing Address - Phone:518-705-5147
Mailing Address - Fax:
Practice Address - Street 1:199 SISSON HILL RD
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:NY
Practice Address - Zip Code:13849-2252
Practice Address - Country:US
Practice Address - Phone:518-705-5147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316125164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse