Provider Demographics
NPI:1992223960
Name:GUNN, JESSICA HANSEN (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HANSEN
Last Name:GUNN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 BLUFFTON PKWY STE 141
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4819 BLUFFTON PARKWAY
Practice Address - Street 2:SUITE 141
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29901
Practice Address - Country:US
Practice Address - Phone:843-757-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236077163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health