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General NPI Number Information
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NPI Number | 1982903027
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Entity Type | Individual
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Provider Name | NICOLE RUTH JESSEN MS, ATC, LAT, PES
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Gender | Female
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Dates
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Enumeration Date | 03/15/2011
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 2830 NAPOLEON RD
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City | FREMONT
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State | OH
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Zip | 43420-9814
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Country | US
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Telephone | 419-559-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 3218 ELMONT RD APT 2
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City | TOLEDO
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State | OH
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Zip | 43615-1478
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Country | US
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Telephone | 440-554-9285
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | AT.003428
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT9279
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT003428
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License Number State | OH
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