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General NPI Number Information
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NPI Number | 1215390331
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Entity Type | Individual
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Provider Name | JESSICA LYNN FORNIERI ATC
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 3700 O ST NW
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City | WASHINGTON
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State | DC
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Zip | 20057-0002
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Country | US
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Telephone | 202-687-6674
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Fax |
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Provider Business Mailing Address
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Address Line | 964 MANOR LN
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City | BAY SHORE
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State | NY
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Zip | 11706-7506
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Country | US
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Telephone | 631-456-1330
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | LAT-2710
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License Number State | NC
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