Provider Demographics
NPI:1750343596
Name:MCFALL, JESSICA BRIDGES (LPN)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:BRIDGES
Last Name:MCFALL
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 1:2533 BINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4916
Mailing Address - Country:US
Mailing Address - Phone:808-254-0875
Mailing Address - Fax:
Practice Address - Street 1:2533 BINGHAM WAY
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-4916
Practice Address - Country:US
Practice Address - Phone:808-254-0875
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217272164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse