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General NPI Number Information
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NPI Number | 1417384611
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Entity Type | Individual
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Provider Name | JESSICA LEIGH SHAVER RN, BSN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2013
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Last Update Date | 10/02/2013
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Provider Practice Location Address
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Address Line | 4184 MILLER ST
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City | WILLIAMSON
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State | NY
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Zip | 14589-9713
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Country | US
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Telephone | 315-589-9665
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Fax | 315-589-8314
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Provider Business Mailing Address
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Address Line | PO BOX 900
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City | WILLIAMSON
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State | NY
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Zip | 14589-0900
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Country | US
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Telephone | 315-589-9665
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Fax | 315-589-8314
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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 | 163WS0200X
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Taxonomy Name | School Registered Nurse
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License Number | 562347-1
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License Number State | NY
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