MEDICARE: JESSICA M POURNARAS CD

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
1	374J00000X	Doula

General Provider Information

NPI Number	:	1639716566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA M POURNARAS CD

Provider Business Mailing Address
First Line	:	645 E 26TH ST APT 3K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2161
Country	:	US
Telephone Number	:	646-385-2297
Fax Number	:

Provider Business Practice Location Address
First Line	:	645 E 26TH ST APT 3K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2161
Country	:	US
Telephone Number	:	646-385-2297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2019
Last Update Date	:	12/10/2019

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