Provider Demographics
NPI:1942569660
Name:JESSAR, JUBETSY R
Entity Type:Individual
Prefix:
First Name:JUBETSY
Middle Name:R
Last Name:JESSAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PREM
Other - Middle Name:
Other - Last Name:AMRITA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1094 JASMINE STREET
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220
Mailing Address - Country:US
Mailing Address - Phone:774-286-1258
Mailing Address - Fax:
Practice Address - Street 1:1094 JASMINE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4518
Practice Address - Country:US
Practice Address - Phone:774-286-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula