Healthcare Provider Details

I. General information

NPI: 1598430290
Provider Name (Legal Business Name): JESSICA L BATES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 CLIFTON BLVD
TOLEDO OH
43607-2220
US

IV. Provider business mailing address

544 CLIFTON BLVD
TOLEDO OH
43607-2220
US

V. Phone/Fax

Practice location:
  • Phone: 419-806-6934
  • Fax:
Mailing address:
  • Phone: 419-806-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN-305555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: