Basic Information
| Provider Information | |||||||||
| NPI: | 1225475171 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADDAI | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54 ORCHARD ST | ||||||||
| Address2: | |||||||||
| City: | MANSFIELD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449031328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196106582 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 508 FULTON ST | ||||||||
| Address2: | B10017 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277053875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192860411 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2013 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 252746 | NC | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN.358466 | OH | Y | Nursing Service Providers | Registered Nurse | 163W00000X | RN9307669 | FL | N | Nursing Service Providers | Registered Nurse | 163W00000X | RN637068 | PA | N | Nursing Service Providers | Registered Nurse | 163W00000X | 0001240556 | VA | N | Nursing Service Providers | Registered Nurse |
No ID Information.