Healthcare Provider Details

I. General information

NPI: 1285079004
Provider Name (Legal Business Name): JESSICA MAE URZEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 6TH AVE SE
HICKORY NC
28602-8335
US

IV. Provider business mailing address

810 FAIRGROVE CHURCH RD SE
HICKORY NC
28602-9617
US

V. Phone/Fax

Practice location:
  • Phone: 828-732-7249
  • Fax:
Mailing address:
  • Phone: 828-732-7249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2017-00983
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1285079004
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: