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General NPI Number Information
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NPI Number | 1578873154
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Entity Type | Individual
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Provider Name | JESSICA ALISON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/13/2017
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Provider Practice Location Address
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Address Line | 2555 E 13TH ST STE 110
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City | LOVELAND
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State | CO
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Zip | 80537-5134
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Country | US
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Telephone | 970-820-4264
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Fax |
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Provider Business Mailing Address
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Address Line | 2555 E 13TH ST STE 110
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City | LOVELAND
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State | CO
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Zip | 80537-5134
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Country | US
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Telephone | 970-820-6140
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 005939
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License Number State | GA
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