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General NPI Number Information
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NPI Number | 1609342054
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Entity Type | Individual
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Provider Name | JESSICA BEZDZIECKI
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Gender | Female
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Dates
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Enumeration Date | 10/23/2018
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 2301 ERWIN RD
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City | DURHAM
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State | NC
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Zip | 27705-4699
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Country | US
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Telephone | 919-864-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 504 E PETTIGREW ST APT 604
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City | DURHAM
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State | NC
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Zip | 27701-3898
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Country | US
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Telephone | 703-994-0748
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 123632
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License Number State | NC
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