Provider Demographics
NPI:1912171018
Name:ANDERSON, JESSICA L (CNS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 STATE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3614
Mailing Address - Country:US
Mailing Address - Phone:330-253-9727
Mailing Address - Fax:330-920-3124
Practice Address - Street 1:3033 STATE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3614
Practice Address - Country:US
Practice Address - Phone:330-253-9727
Practice Address - Fax:330-920-3124
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS 07214364SA2200X
OHNP15854363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2812675Medicaid
OH2812675Medicaid
H338260Medicare PIN