Provider Demographics
NPI:1841867603
Name:DLUGOLECKI, JESSICA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:DLUGOLECKI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 ERIE BLVD E
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-2227
Mailing Address - Country:US
Mailing Address - Phone:153-251-2244
Mailing Address - Fax:
Practice Address - Street 1:5856 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-3012
Practice Address - Country:US
Practice Address - Phone:315-298-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty