Provider Demographics
NPI:1205167285
Name:JESSEN, ELEANOR GAIL (FNP-BC)
Entity type:Individual
Prefix:
First Name:ELEANOR
Middle Name:GAIL
Last Name:JESSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ELEANOR
Other - Middle Name:GAIL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:588 BAKERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1517
Mailing Address - Country:US
Mailing Address - Phone:304-550-2907
Mailing Address - Fax:304-561-6326
Practice Address - Street 1:1740 COONSKIN DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1026
Practice Address - Country:US
Practice Address - Phone:304-561-6324
Practice Address - Fax:304-561-6326
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily