Provider Demographics
NPI:1982100491
Name:VECCIA, JESSALINE
Entity Type:Individual
Prefix:
First Name:JESSALINE
Middle Name:
Last Name:VECCIA
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 1:8968 N MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-1021
Mailing Address - Country:US
Mailing Address - Phone:330-219-3115
Mailing Address - Fax:
Practice Address - Street 1:8968 N MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-1021
Practice Address - Country:US
Practice Address - Phone:330-219-3115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker