Provider Demographics
NPI:1457752388
Name:EDMONDSON, JESSICA LYNNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNNE
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11142 N 165TH DR APT 109
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85388-6644
Mailing Address - Country:US
Mailing Address - Phone:252-955-7531
Mailing Address - Fax:
Practice Address - Street 1:17359 W SURPRISE FARMS LOOP N
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85388-0283
Practice Address - Country:US
Practice Address - Phone:623-523-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270274163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool