Provider Demographics
NPI:1720109366
Name:JESSMORE, PAULA J (RN, NP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:JESSMORE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-1369
Mailing Address - Country:US
Mailing Address - Phone:315-452-5800
Mailing Address - Fax:
Practice Address - Street 1:115 CREEK CIR
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-1369
Practice Address - Country:US
Practice Address - Phone:315-452-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP19635Medicare UPIN
NYCC3366Medicare ID - Type Unspecified