Provider Demographics
NPI:1932466620
Name:JESSOP, ELLEN DOUGLAS (APRN)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:DOUGLAS
Last Name:JESSOP
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HEALTHCARE DRIVE, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867
Mailing Address - Country:US
Mailing Address - Phone:603-330-3404
Mailing Address - Fax:603-332-8175
Practice Address - Street 1:6 HEALTHCARE DRIVE, SUITE 2
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867
Practice Address - Country:US
Practice Address - Phone:603-330-3404
Practice Address - Fax:603-332-8175
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283305363LA2200X
NH063716-23363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health