Healthcare Provider Details

I. General information

NPI: 1386343655
Provider Name (Legal Business Name): JESSICA DYBUS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 ROUTE 50 STE L
MAYS LANDING NJ
08330-2158
US

IV. Provider business mailing address

2106 NEW RD STE F2
LINWOOD NJ
08221-1053
US

V. Phone/Fax

Practice location:
  • Phone: 609-625-7116
  • Fax:
Mailing address:
  • Phone: 604-796-7969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ14987300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number26NR21783100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: