Provider Demographics
NPI:1982836201
Name:WURM, JESSE M
Entity Type:Individual
Prefix:MR
First Name:JESSE
Middle Name:M
Last Name:WURM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-4009
Mailing Address - Country:US
Mailing Address - Phone:209-668-6112
Mailing Address - Fax:209-668-9701
Practice Address - Street 1:352 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-4009
Practice Address - Country:US
Practice Address - Phone:209-668-6112
Practice Address - Fax:209-668-9701
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABHS-MH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator