Provider Demographics
NPI:1255885935
Name:BIOSSE, JESSICA
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:BIOSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:BANDELOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2545 26TH AVE
Mailing Address - Street 2:APT. #9
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1943
Mailing Address - Country:US
Mailing Address - Phone:925-389-1712
Mailing Address - Fax:
Practice Address - Street 1:2545 26TH AVE
Practice Address - Street 2:APT. #9
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1943
Practice Address - Country:US
Practice Address - Phone:925-389-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-10
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other