Provider Demographics
NPI:1013244722
Name:DAURIA, JESSA IRENE (ARNP)
Entity Type:Individual
Prefix:
First Name:JESSA
Middle Name:IRENE
Last Name:DAURIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S ALBANY ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5404
Mailing Address - Country:US
Mailing Address - Phone:206-724-2305
Mailing Address - Fax:
Practice Address - Street 1:217 N AURORA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4345
Practice Address - Country:US
Practice Address - Phone:607-273-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60116854363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9664202Medicaid
WAG8890177Medicare PIN