Provider Demographics
NPI:1336580877
Name:SLEESMAN-VITT, JESSICA L (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:SLEESMAN-VITT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 NEW VISION DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1703
Mailing Address - Country:US
Mailing Address - Phone:260-266-8207
Mailing Address - Fax:
Practice Address - Street 1:409 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:IN
Practice Address - Zip Code:46721-1175
Practice Address - Country:US
Practice Address - Phone:260-920-2000
Practice Address - Fax:260-920-2005
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28177718A363L00000X
IN71004599A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201184480Medicaid
IN191560001Medicare PIN