Healthcare Provider Details

I. General information

NPI: 1689555252
Provider Name (Legal Business Name): JESSICA DRIVER CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 IRVING BLVD NW APT 1002
ALBUQUERQUE NM
87114-3907
US

IV. Provider business mailing address

4701 IRVING BLVD NW APT 1002
ALBUQUERQUE NM
87114-3907
US

V. Phone/Fax

Practice location:
  • Phone: 505-295-9350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberNM007974101845
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: