Provider Demographics
NPI:1811771512
Name:PORTELLI, JESSILEE JEAN
Entity type:Individual
Prefix:
First Name:JESSILEE
Middle Name:JEAN
Last Name:PORTELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1240
Mailing Address - Country:US
Mailing Address - Phone:607-316-2938
Mailing Address - Fax:
Practice Address - Street 1:89 MIDLAND DR
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2242
Practice Address - Country:US
Practice Address - Phone:607-334-1600
Practice Address - Fax:607-334-1666
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY628654163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse