Provider Demographics
NPI:1649522111
Name:LIBERTY, JESSICA JEAN (RN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:JEAN
Last Name:LIBERTY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 STATE ROUTE 3
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-3728
Mailing Address - Country:US
Mailing Address - Phone:518-593-5625
Mailing Address - Fax:
Practice Address - Street 1:1750 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:MORRISONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12962-3728
Practice Address - Country:US
Practice Address - Phone:518-593-5625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631008163WM0705X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical