Provider Demographics
NPI:1336587591
Name:JESSEE, REBECCA A
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name:JESSEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SILVER LN STE 476B
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:IN
Mailing Address - Zip Code:47470-8941
Mailing Address - Country:US
Mailing Address - Phone:812-388-7270
Mailing Address - Fax:
Practice Address - Street 1:1 SILVER LN STE 476B
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:IN
Practice Address - Zip Code:47470-8941
Practice Address - Country:US
Practice Address - Phone:812-388-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042179A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics