Healthcare Provider Details

I. General information

NPI: 1013244722
Provider Name (Legal Business Name): JESSA IRENE DAURIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N AURORA ST
ITHACA NY
14850-4345
US

IV. Provider business mailing address

218 S ALBANY ST APT 2
ITHACA NY
14850-5404
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-2811
  • Fax:
Mailing address:
  • Phone: 206-724-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAP60116854
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: