Provider Demographics
NPI:1801300959
Name:HENDERSON, JESSYCA ELIZABETH (RN)
Entity type:Individual
Prefix:MRS
First Name:JESSYCA
Middle Name:ELIZABETH
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JESSYCA
Other - Middle Name:ELIZABETH
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1741 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-4255
Mailing Address - Country:US
Mailing Address - Phone:330-802-4935
Mailing Address - Fax:
Practice Address - Street 1:1741 HANOVER ST
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-4255
Practice Address - Country:US
Practice Address - Phone:330-802-4935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN393435163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse