Provider Demographics
NPI:1669805727
Name:MOSUR, JESSICA LEIGH (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:MOSUR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 15TH ST
Mailing Address - Street 2:
Mailing Address - City:MENOMINEE
Mailing Address - State:MI
Mailing Address - Zip Code:49858-1850
Mailing Address - Country:US
Mailing Address - Phone:715-587-3388
Mailing Address - Fax:
Practice Address - Street 1:2810 15TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-1850
Practice Address - Country:US
Practice Address - Phone:715-587-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI307422-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse