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NPI Code Detail

MEDICARE: JESSICA FAYE CEAN RPN

MEDICARE: JESSICA FAYE CEAN RPN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse717400NY

General Provider Information

NPI Number : 1548715691
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA FAYE CEAN RPN
Provider Business Mailing Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-782-1777
Fax Number : 315-785-8628
Provider Business Practice Location Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-782-1777
Fax Number : 315-785-8628
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2016
Last Update Date : 08/25/2016

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