Healthcare Provider Details

I. General information

NPI: 1134607252
Provider Name (Legal Business Name): JESSICA LYNN SAUNDERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/07/2020
Certification Date: 02/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RALSTON AVE
DEFIANCE OH
43512-1396
US

IV. Provider business mailing address

5731 HAMPTONS DR
MONCLOVA OH
43542-8610
US

V. Phone/Fax

Practice location:
  • Phone: 419-783-6955
  • Fax:
Mailing address:
  • Phone: 419-708-1394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP023359
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: