Healthcare Provider Details

I. General information

NPI: 1427793389
Provider Name (Legal Business Name): JESSICA LEE LUSIGNAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 OLD TUNNEL RD
GRASS VALLEY CA
95945-8524
US

IV. Provider business mailing address

101 W MCKNIGHT WAY SUITE B, PMB 137
GRASS VALLEY CA
95949
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-9762
  • Fax:
Mailing address:
  • Phone: 413-244-3964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95019513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: