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NPI Code Detail

MEDICARE: MS. JESSICA BLUE NURSE PRACTITIONER

MEDICARE: MS. JESSICA BLUE NURSE PRACTITIONER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerF420760NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033193768
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JESSICA BLUE NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 26 BLEECKER ST
Second Line :
City : NEW YORK
State : NY
Zip : 10012-2413
Country : US
Telephone Number : 212-274-7250
Fax Number :
Provider Business Practice Location Address
First Line : 26 BLEECKER ST
Second Line :
City : NEW YORK
State : NY
Zip : 10012-2413
Country : US
Telephone Number : 212-274-7250
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2005
Last Update Date : 01/17/2012

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