Healthcare Provider Details

I. General information

NPI: 1841627973
Provider Name (Legal Business Name): JESSICA MESSERSMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 W STATE ST UNIT #1
ITHACA NY
14850-5221
US

IV. Provider business mailing address

531 W STATE ST UNIT #1
ITHACA NY
14850-5221
US

V. Phone/Fax

Practice location:
  • Phone: 716-838-6060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number622650
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: