Provider Demographics
NPI:1184344376
Name:KABANA, JESSE (MSN, CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:KABANA
Suffix:
Gender:M
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 FOSTER ST
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2123
Mailing Address - Country:US
Mailing Address - Phone:570-778-7210
Mailing Address - Fax:
Practice Address - Street 1:1716 MAIN ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:PA
Practice Address - Zip Code:18447-1362
Practice Address - Country:US
Practice Address - Phone:570-342-3314
Practice Address - Fax:570-342-3315
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine