Provider Demographics
NPI:1295927457
Name:LIBISZEWSKI, JESSICA B (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:B
Last Name:LIBISZEWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2772
Mailing Address - Country:US
Mailing Address - Phone:413-589-7176
Mailing Address - Fax:413-589-7710
Practice Address - Street 1:200 CENTER ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2772
Practice Address - Country:US
Practice Address - Phone:413-589-7176
Practice Address - Fax:413-589-7710
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA251249OtherLICENSE NO