Provider Demographics
NPI:1700325313
Name:FERN, JESSICA (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FERN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PUTTER WAY
Mailing Address - Street 2:
Mailing Address - City:CAMDEN WYOMING
Mailing Address - State:DE
Mailing Address - Zip Code:19934-4007
Mailing Address - Country:US
Mailing Address - Phone:302-270-6471
Mailing Address - Fax:
Practice Address - Street 1:56 PUTTER WAY
Practice Address - Street 2:
Practice Address - City:CAMDEN WYOMING
Practice Address - State:DE
Practice Address - Zip Code:19934-4007
Practice Address - Country:US
Practice Address - Phone:302-270-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH020526363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care