Healthcare Provider Details

I. General information

NPI: 1770196867
Provider Name (Legal Business Name): JESSICA NAIL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA JEAN BONURA RN

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 BROCKENBRAUGH CT
METAIRIE LA
70005-1610
US

IV. Provider business mailing address

1240 BROCKENBRAUGH CT
METAIRIE LA
70005-1610
US

V. Phone/Fax

Practice location:
  • Phone: 504-338-1123
  • Fax:
Mailing address:
  • Phone: 504-338-1123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN145267
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: