Healthcare Provider Details

I. General information

NPI: 1609420801
Provider Name (Legal Business Name): JESSICA LYNNE SANKY WEIR FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2019
Last Update Date: 03/10/2023
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 BEECH ST
HOLYOKE MA
01040-2223
US

IV. Provider business mailing address

262 NEW LUDLOW RD
CHICOPEE MA
01020-4324
US

V. Phone/Fax

Practice location:
  • Phone: 413-534-2669
  • Fax: 413-540-5055
Mailing address:
  • Phone: 413-535-4714
  • Fax: 413-535-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2300838
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2300838
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: