Healthcare Provider Details

I. General information

NPI: 1073972279
Provider Name (Legal Business Name): JESSICA LYNN LORENZO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA LYNN MOORE FNP

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 WALNUT ST SUITE 1
COSHOCTON OH
43812-2289
US

IV. Provider business mailing address

340 OXFORD ST SUITE 1
DOVER OH
44622-1965
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-3016
  • Fax:
Mailing address:
  • Phone: 740-622-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: